Concluded Case

ATYPICAL PBF and CBC ?

51 years old male with right shoulder pain came in O.P.D 2 days - along with symptomatic treatment he was investigating- considering his facial features with facial puffiness His KFT was normal TSH was 10.98 CBC was remarkable- with TLC - 18000 and Absolute lymphocyte count- 14 , 400. PBF - Many atypical/ activated lymphocytes seen Further approach with this,patient

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Concluded answer

Need la to rule out Chronic Lymphocytic lymhoma No need to do Bone marrow evaluation in CLL Send to Medical Oncologist or Hematooncologist

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Hypothyroidism is very much concerned.. High lymphocyte blood levels indicate your body is dealing with an infection or other inflammatory condition. Most often, a temporarily high lymphocyte count is a normal effect of your body's immune system working. Sometimes, lymphocyte levels are elevated because of a serious condition, like leukemia.. Lymphoproliferative disorders (LPDs) refer to several conditions in which lymphocytes are produced in excessive quantities. They typically occur in people who have a compromised immune system.. Here platelets count is very low. It is advised to consult hematologist before starting any medicine.

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Atypical lymphocytes in pbf with lymphocytosis need BONE MARROW Likely a c/o lymphocytic leukaemia High TSH suggest hypothyroidism Leucocytosis suggest infective reason may be septic artheritis Rx broadspectrum antibiotics iv injectable Inj Ceftriaxozone Inj dexamethasone Tab L-thyroxine 50ug 1od Antiinflamatory Rest after bone marrow Adv xray chest Usg abdomen To look for secondaries

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Here a matter of concern is leukocytosis with lymphocytosis which indicates immune system of the body is active now Suggestive of acute lymphocytic leukaemia or acute infection Pt is having acute pain rt shoulder may be due ? pathological fracture of humerus or acute infective process of rt shoulder Suggestive Xray shoulder Bone marrow biopsy

Hypothyroidism with lymphocytosis leucocytosis Mri of shoulder may be streptococcal infection Aso test 3 d echo Other dd ebv or infectious mononucleosis

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Need la to rule out Chronic Lymphocytic lymhoma No need to do Bone marrow evaluation in CLL Send to Medical Oncologist or Hematooncologist

SUGGESTIVE OF .LYMPHOCYTIC LEUKAEMIA WITH HYPOTHYROIDISM AND SEPTICEMIA.... SEPTIC. ARTHRITIS NEEDS. FURTHER. EVALUATION

Can be CLPD...to do peripheral blood Flow..at present look like there is no indication for treatment of CLL..TREAT hypothyroidism

High tsh c/o hypothyroidism Wbc raised with atypical lymphocytes May be Leukemia Bone marrow study necessary

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Most likely case of CLPD ...need bone marrow , flowcytometry and cytogenetics....

Hypothyroidism with leucocytosis