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The page below is a sample from the LabCE course White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Case Study Three

Case Study Three:
A 14-year-old boy came to the physician's office with a sore throat that progressively worsened over a three-day period. His posterior pharynx was swollen, shiny and erythematous. The boy complained of pain on swallowing. His temperature was 98.5°F.
A rapid direct streptococcal antigen test was positive. However, his symptoms did not subside over the next two days while on antibiotic therapy. Anorexia and nausea were persistent and compounded by a frontal headache. Cervical lymph nodes became noticeably enlarged.
A complete blood count (CBC) was ordered.
The results of the CBC were:
WBC 11.9 x 109/L ( Reference interval= 3.8 - 9.8 x 109/L) with:
  • 17% segmented neutrophils
  • 5% band neutrophils
  • 72% lymphocytes
  • 6% monocytes
  • All red cell findings were normal.
The automated differential flagged for atypical cells, presumptively atypical lymphocytes. A peripheral blood smear was prepared. The image on the right is a representative field from the Wright-Giemsa stained smear (1000X magnification).
A rapid qualitative test for infectious mononucleosis was positive.
This is a case of a concurrent group-A streptococcal infection along with infectious mononucleosis. Symptoms subsided in three weeks following completion of the antibiotic therapy.