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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Chronic Illness But And Viral S/S For A 32-year-old

Hello, Hoping you can help, I am an NP stuck working late caring for the clinic s patients with all other providers on vacation this wk and need a rational provider to bounce off this troubling young pt I saw today please? I never met him before and he is fairly new pt. He is a 32 yo male w/o hx chronic illness but lately has had viral s/s. Was seen in a Boston ER and no info sent here. Labs: elevated wbc: atypical lymph 10.0, Metamyelocytes 1.0 (so high turnover-immature cells), Monocytes 12.0, Platelet borderline low 162, rest cbc nl, pancreatic enzymes nl, awaiting tick panel (had recent tick bite), awaiting monospot. Exam today had pulse 90 and reg, some diaphoresis, rest exam wnl. Any ideas??? :)
posted on Mon, 4 Jul 2016
Twitter Fri, 24 Feb 2023 Answered on
Twitter Tue, 28 Feb 2023 Last reviewed on
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General & Family Physician,  's  Response
Hi,

Though, the lab reports presented are not adequate to reach at a precise diagnosis, Still presence of atypical lymphocytes in the range of 10% is definitely abnormal and it can be present in a large no. of conditions like immunological reaction to transplantation, collagen disease, lymphomas, leukemia etc. Also, it may be present in various bacterial or viral infections etc.

Similarly, presence of metamyelocyte also is abnormal, even if it is 1%. Occasionally, very rare metamyelocyte may be present in blood in severe infections due to heavy turn out from bone marrow. However, initial stage of leukemia may not be overlooked. Also, the exact no. of WBC count may be helpful for a proper diagnosis, but it has not been provided in the report. Similarly, monocyte count is also on a higher side than normal.

By, all means the patient needs to be investigated further for a proper diagnosis. The urgent need of complete blood count along with a peripheral smear cytology, bone marrow aspiration / biopsy and lymph node biopsy are the required tests to be done on priority bases for this patient. In the meantime, just an approach of symptomatic treatment along with maintenance of vital parameters is required.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Satnarain Bansal, General & Family Physician
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General & Family Physician,  Dr. Sunny Madar's  Response
Hi,

Atypical lymphocytes and metamyelocytes needs flow throw and cytometry plus minus bone marrow examination, it can be leukemia but until diagnosed not sure.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Sunny Madar, General & Family Physician
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Suggest Treatment For Chronic Illness But And Viral S/S For A 32-year-old

Hi, Though, the lab reports presented are not adequate to reach at a precise diagnosis, Still presence of atypical lymphocytes in the range of 10% is definitely abnormal and it can be present in a large no. of conditions like immunological reaction to transplantation, collagen disease, lymphomas, leukemia etc. Also, it may be present in various bacterial or viral infections etc. Similarly, presence of metamyelocyte also is abnormal, even if it is 1%. Occasionally, very rare metamyelocyte may be present in blood in severe infections due to heavy turn out from bone marrow. However, initial stage of leukemia may not be overlooked. Also, the exact no. of WBC count may be helpful for a proper diagnosis, but it has not been provided in the report. Similarly, monocyte count is also on a higher side than normal. By, all means the patient needs to be investigated further for a proper diagnosis. The urgent need of complete blood count along with a peripheral smear cytology, bone marrow aspiration / biopsy and lymph node biopsy are the required tests to be done on priority bases for this patient. In the meantime, just an approach of symptomatic treatment along with maintenance of vital parameters is required. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Satnarain Bansal, General & Family Physician