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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 Four

Case Study Four:
An 80-year-old man was seen in the emergency room after a sudden onset of chest pain accentuated on inspiration. His cough was productive of yellow sputum, and he was short of breath. His temperature was 101.2°F. A chest X-ray revealed right middle lobe pneumonia.
A complete blood count (CBC) was ordered. The results were as follows:

CBC Parameter
Patient Result
Reference Interval
WBC
33.0 x 109/L
4.0 - 11.0 x 109/L
RBC
4.5 x 1012/L
4.5 - 5.9 x 1012/L
Hemoglobin
15.2 g/dL
13.5 - 17.5 g/dL
Hematocrit
44%
41 - 53%
Platelet
200 x 109/L
150 - 450 x 109/L
Segmented neutrophil
65
40 - 80%
Band neutrophil
10
0 - 5%
Lymphocyte
5
25 - 35%
Eosinophil
3
0 - 5%
Basophil
2
0 - 2%
Monocyte
25
2 - 10%

A peripheral smear was reviewed based on the elevated WBC and increased monocyte count. A representative field from the Wright-Giemsa stained smear (1000X magnification) is shown on the right. The cells indicated by the blue arrows are atypical monocytes. They have abundant cytoplasm that is more blue than the typical gray-blue cytoplasm of normal monoctes. A few scattered vacuoles are also present. The atypical monocytes, in company with toxic neutrophils (indicated by the red arrow), appeared to be a response to infection. The patient had a past history of tuberculosis, which may account for the monocytosis.