A 48-year-old alcoholic man presents with a 6-day history of productive cough and fever. The temperature is 38.7degC (103degF), respirations are 32 per minute, and blood pressure is 126/86 mm Hg. The patient's cough worsens, and he begins expectorating large amounts of foul-smelling sputum. A chest X-ray shows a right upper and middle lobe infiltrate. A CBC demonstrates leukocytosis (WBC = 38,000/mL), with 80% slightly immature neutrophils and toxic granulation. Laboratory studies reveal elevated leukocyte alkaline phosphatase. Which of the following best describes this patient's hematologic condition?
Neutrophilia is an absolute neutrophil count above 7,000/mL. In acute infections, neutrophilia may be so pronounced that it may be mistaken for leukemia, especially, chronic myelogenous leukemia (CML), in which case it is termed a leukemoid reaction. Clues to the benign (or reactive) nature of a leukemoid reaction include the following: (1) the cells in the peripheral blood smear are more mature than myelocytes;(2) leukocyte alkaline phosphatase activity is high in benign conditions and low in patients with CML (3) Benign neutrophils often contain large blue cytoplasmic inclusions referred to as "Dohle bodies" or toxic granulation. Diagnosis: Leukemoid reaction A.cytoplasmic granulation and numerous bluish Dohle bodies
Acute myelogenous leukemia
Chronic lymphocytic leukemia
Chronic myelogenous leukemia
Leukemoid reaction
Chronic Myelogenous Leukemia