Lab Two B: Myelodysplastic and Myeloproliferative Syndromes

Case 1


Case Presentation

A 42 year old Caucasian woman previously in good health experienced increasingly heavy menses and gum bleeding when brushing her teeth over the last four months. In the last week she noticed small purple spots on her legs. She felt very tired and although she initially thought her bleeding to be premenopausal, she decided to see a doctor.

Physical examination showed a pale thin patient with petechiae on both legs. There was no organomegaly and the lymph nodes are not palpable.

CBC:

  Patient Normal Female
WBC 3.5 x103 3.5 – 10.6 x103 /μL
WBC differential % (absolute) % (absolute)
  Blasts 1 % (35) 0.0 % (0 /μL)
  Bands 0 % (0) 0 – 10% (0 - 720/μL)
  Neutrophils 21 % (735) 38 - 76 % (1,730 – 7,100 /μL)
  Monocytes 4 % (140) 1 - 12 % (70 – 870 /μL)
  Lymphocytes 72 % (2520) 11 - 46 % (900 – 3,120 /μL)
  Eosinophils 1 % (35) 0 - 8 % (0 – 490 /μL)
  Basophils 1 % (35) 0 - 2 % (0 – 140 /μL)
RBC 2.9 x106 3.91 - 5.15 x106 /μL
HGB 6.5 11.5 - 15.1 g/dL
MCV 108 82.0– 97.0 fL
RDW 17 11.7 - 14.9 %
Platelets 19 x103 150 - 450 x103 /μL
Comment: Immature myeloid cells present (blasts) and occasional nucleated RBC’s.

Question #1: Based on the clinical history and CBC results, which of the following would NOT be included in your differential diagnosis?