The same critical value of white blood cells, the same increase in the proportion of lymphocytes, seems to be the same, but it is not

Seemingly the same blood routine results, the diagnosis of the disease is completely different, and it can be seen under the microsco.

case after

Case number one

The patient, female, 68 years old, was admitted to the hospital on March 29, 2022 with the main complaint of "mantle cell lymphoma for more than one yea.

The results of the patient's initial blood routine at admission attracted our attention: the white blood cells were 452×109/L, and the lymphocyte percentage was 9

At the same time, if a lymphoma patient has abnormally elevated lymphocytes, will the lymphoma invade the peripheral blood? With these two speculations in mind, we prepared blood slices and prepared to investigate them under the microsco.

Microscopically, the patient's leukocytes were indeed dominated by lymphocytes, with consistent morphology, small cells, little cytoplasm, and dimples or deep and narrow fissures in the nucle.

The patient's disease is mantle cell lymphoma, which is a mature B cell-derived lymphoma [

(Wright staining 10×100 times)

Case 2

The patient, male, 66 years old, was admitted to the hospital on April 14, 2022 with the main complaint of "Cardia cancer in June, half a month after chemotherap.

The patient's admission blood routine also showed that the critical value of white blood cells was 539×109/L, and the percentage of lymphocytes was 8

Microscopically, the white blood cells are indeed mainly lymphocytes, with small, round or oval cell bodies; little or no cytoplasm; dark purple-red, round nuclei; dense nuclear chromat.

(Wright staining 10×100 times)

case analysis

The blood picture with increased white blood cells and increased lymphocyte percentage is generally more common in viral infection, but when the number of white blood cells is significantly increased and the lymphocyte percentage is increased, it is more common in acute/chronic lymphocytic leukemia, leukemia-like reaction (lymphocytic type), Lymphoma, leukemia,e.

The peripheral blood of acute/chronic lymphocytic leukemia is mostly mature lymphocytes, primitive or immature lymphocytes can be seen, and smear cells are easy to s.

The peripheral blood in the lymphoma leukemia stage is dominated by abnormal lymphocyt.

The peripheral blood of leukemia-like reaction (lymphocytic type) is dominated by mature lymphocytes, immature lymphocytes and atypical lymphocytes can be seen, and the increase of primary lymphocytes and smear cells is not obvious [

Summary

As a routine test item, routine blood test cannot provide a definitive basis for the diagnosis of the disease, but routine blood test + microscopy can provide a valuable diagnostic direction for the disease, and at the same time make the diagnosis based on the clinical manifestations of the patient and other laboratory tes.

Expert Reviews

Zhu Weiwei (Deputy Director, Deputy Chief Technician, Department of Medical Laboratory, Anyang Cancer Hospital)

Today, with the ever-changing inspection technology, traditional microscopy is still inseparable, especially in the diagnosis of blood system diseas.

references

[1] Xu Jing, Mei Hong, Geng Zhaohui, et .

[2] Xu Wei, Zhu Huayuan, Wu Yujie, et .

Diagnosis, prognosis and treatment of chronic lymphocytic leukemia [.

National Academic Conference on Hematology of Chinese Medical Associati.

Chinese Medical Association, 201

[3] Pu Qu.

Diagnosis and differential diagnosis of leukemia-like reaction [.

New Medicine, 200