Our patient has a mildly elevated lymphocyte count and this is persistent on repeat. In the absence of reactive causes the most likely explanation is a low grade lymphoproliferative neoplasm such as CLL. After a period of monitoring the patient’s lymphocyte count rises:

• Hb 140g/l (115-165)
• MCV 95fl (82-98)
• WCC 30.4×10⁹/l (4-11)
• Neutrophils 5.7×10⁹/l (1.7-7.5)
• Lymphocytes 23.3×10⁹/l  (1.5-4.5)
• Platelets 232×10⁹/l (150-450)

Here is the film:

A haematologist contacts you as the laboratory have performed flow cytometry:

Questions

• What is the most likely diagnosis?
• What questions are you going to ask?
• What test can confirm the diagnosis?

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