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Case Two

A 60-year-old man presented to the emergency department with complaints of fatigue and weakness which began during the previous week. He also stated that he had been experiencing shortness of breath without chest pain, cough, or dizziness. Upon physical examination, he had normal vital signs. However, his spleen was mildly enlarged.

Laboratory tests were ordered. The white blood count (WBC) and absolute lymphocyte counts were both elevated:

WBC= 28.5 x 109/L (normal 4 - 10)
Lymphocyte count= 20.0 x 109/L (normal 1.2 - 4.0)

A manual differential confirmed the elevated lymphocyte count. Smudge cells were also noted, as shown in the image.

To evaluate the patient's lymphocytosis, a blood sample was submitted for flow cytometry analysis.