Approach to leukemia Quiz: Ace Your Exams
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A 68-year-old man presents to his primary care doctor for evaluation of persistent fatigue over the past several months. He has not had significant weight loss, fever, night sweats, or bleeding. Past medical history is significant for hypertension, controlled with lisinopril. Temperature is 36.7°C (98.1°F), heart rate 74/min, respiratory rate 14/min, blood pressure 132/82 mm Hg, and oxygen saturation 98% on room air. BMI is 23 kg/m2. Physical examination is notable for mild splenomegaly. No lymphadenopathy is palpable. Laboratory evaluation is shown below. Given the most likely underlying condition, which of the following is most likely to be seen on the peripheral blood smear?
| Complete Blood Count | Reference Range |
| Hemoglobin | 13.8 g/dL | 13.5-17.5 g/dL |
| Hematocrit | 41.2% | 41-53% |
| Platelets | 220,000/µL | 150,000-400,000/µL |
| White blood cells (WBC) | 20,000/µL | 4,500-11,000/µL |
| Neutrophils | 30% | 54-62% |
| Lymphocytes | 65% | 25-33% |
| Monocytes | 3% | 3-7% |
| Eosinophils | 1% | 1-3% |
| Basophils | 1% | 0-0.75% |
| Electrolytes | ||
| Sodium | 140 mEq/L | 136-146 mEq/L |
| Potassium | 4.2 mEq/L | 3.5-5 mEq/L |
| Chloride | 100 mEq/L | 95-105 mEq/L |
| Bicarbonate | 24 mEq/L | 22-28mEq/L |
| Calcium | 9.4 mg/dL | 8.4-10.2 mg/dL |
| Renal Function | ||
| Creatinine | 1.0 mg/dL | 0.6-1.2 mg/dL |
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