General and Systemic Histopathology, C601&C602

    Virtual Slide: This 70-year-old man complains of fatigue.

    This 70 year-old white man complains of fatigue, decreased exercise tolerance and what describes as a "pulling" sensation in his abdomen. He has always been in good health, is able to walk several miles a day and lives alone.

    Physical reveals a well developed and well nourished man who is slightly pale and looks a little younger than his stated age. He has enblarged and non-tender cervical lymphadenopathy and spleen tips is easily palpated at the level of the umbilicus. The liver seems enlarged.

    WBC  107 X 103   RBC    2.76 Reference values?
          Percent   HGB    10  
    NE    7.8   HCT     29.8  
    LY    78.6   MCV    108  
    MO   13.6   MCH     36.1  
    EO       0   MCHC   33.4  
    BA        0   RDW     15.0  
    Many Smudge cells   PLT      26 X 103  
        MPV     6.9  
    Click the little red + in the smear above to see the slide using the virtual microscope. Describe what you see and then answer the following questions.
    • What's wrong here?
    • Why the anemia and thrombocytopenia?
    • Do you think the MCV is accurate?
    • What organs are affected by this condition?
    • Morphologic criteria for the disease?
    • How to distinguish CLL from ALL?
    • Mayo Clinic tutorial on this disease (~20 min)

    Next patient has shortness of breath and a cough.


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