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Part III: White Blood Cell Disorders

Findings consistent with infection include:

A. Persistence of primary granules in circulating neutrophils

B. Large circulating lymphocytes containing azurophilic granules

C. The appearance of band cell forms in the peripheral blood

D. Neutrophilia

E. Neutropenia

F. All of the above

The impact of bacterial, viral, fungal, and parasitic infections on the appearance and number of white blood cells is quite variable and diverse. (The answer is F.)

The most frequent cause of clinically significant neutropenia is:

A. Large granular lymphocytic leukemia

B. Congenital abnormalities

C. Severe viral infections

D. Iatrogenic

E. Idiopathic

Many, if not most, of the drugs used to treat cancer are myelosuppressive and therefore predictably cause neutropenia. In addition, a variety of other drugs can lower the neutrophil count in a sporadic or idiosyncratic manner. (The answer is D.)

A 21-year-old African American college student applies for a Rhodes scholarship, which he is granted. Before leaving for England, he is required to have a health form completed. During his evaluation at the University Health Services, a complete blood count (CBC) is obtained. Results show that he has a white blood cell (WBC) count of 3200, with 35% neutrophils. His primary physician tells him to consider holding off on accepting the Rhodes scholarship, and refers him to you for further evaluation. He has no history of excessive infections and has been healthy all his life. His physical exam is normal. His CBC today shows a WBC of 3400 with 30% neutrophils, a hematocrit of 41, and platelets of 200,000. What should you advise him regarding his scholarship?

A. He should have a bone marrow examination to rule out a bone marrow process causing neutropenia.

B. He should go to England without any further evaluation.

C. He should have serial blood counts to rule out cyclic neutropenia.

D. He should have chromosome analysis of his peripheral blood.

Normal healthy individuals of African ancestry have a modest though statistically significant reduction in WBC. (The answer is B.)

A patient is diagnosed with hyperthyroidism and has been started ...

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