67 year old male with pallor & splenomegaly (both incidental finding as patient visited cardiologist for mild breathing difficulty) No other significant findings (No fever) Blood - Macrocytic anemia (Hb - 7.6, MCV 108), neutrophilia (TLC ~ 38000, PMN - 75%- elevated neutrophils for 3 months- physician has given broad spectrum antibiotics several times. No focus of infection found), Thombocytosis (5.5 lacs). PBS - Polychromatic macrocytes, hypersegmented neutrophils, thrombocytosis Ferritin & LDH WNL BMA - hypercellular marrow, M:E increased, (No megaloblastic features), sequential maturation in granulocytic series, with many hypersegmented neutrophils also, Increased megakaryocytes. No dysplastic features in any series.
No hemoparasites seen, Stainable storage iron is increased. others essentially normal. Vit B12 awaited, In view of splenomegaly, persistent neutrophilia &…
