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MALE – 57 YEARS OF AGE, 200 POUNDS, 6 FEET,
Question: MALE – 57 YEARS OF AGE, 200 POUNDS, 6 FEET, 2 INCHES, NO MEDICATIONS, SLIGHTLY ELEVATED BLOOD PRESSURE, NO PRIOR ILLNESSES. FELT A LUMP IN THE ABDOMEN AND THEN WAS DIAGNOSED WITH AN ENLARGED SPLEEN BY THE GI DOCTOR WHO THEN REFERRED ME TO A HEMOTOLOGIST/ONCOLOGIST.
BLOOD TESTING RESULTS:
ABNORMAL TEST RESULTS:
BETA 2 MICROGLOBULIN: 2.5 (HIGH) – NORMAL RANGE: 0.8 – 2.2
RBC: 4.22 (LOW) – NR: 4.5 – 6.5
HCT: 39.4 (LOW) – NR: 40 – 54
MCH: 33.2 (HIGH) – NR: 27 – 32
PLAT: 74 (LOW) – NR: 150 -500
LYMPH%: 18.1 (LOW) – NR: 20.5 – 51.1
LYMPH#: 0.9 (LOW) – NR: 1.2 – 3.4
F KAPPA LT CHAIN 20.2 (HIGH) – NR 3.3 – 19.4
CO2: 21 (LOW) – NR: 22 – 29
CORRECTED SERUM CALCIUM: 8.4 (LOW) – NR: 8.6 – 10
FIBRINOGEN ACTIV, CLAUSS: 128 (LOW) – NR: 193 – 507
HAPTOGLOBIN: 24 (LOW) – NR: 30 – 200
PLATELET, BLUE TOP: 67 (LOW) – NR: 150 – 500
PROTIME: 12.2 (HIGH) – NR: 9.1 – 12
INR: 1.2 (HIGH) – NR: 0.8 – 1.1
URIC ACID: 8.0 (HIGH) – NR: 3.4 – 7
DIRECT ANTIGLOBULIN (DAT): POSITIVE
NORMAL TEST RESULTS:
IgA, IgM, IgG (Quiggs)
F LAMDA LT CHAIN
KAPPA LAMBDA RATIO
ANA COMPREHENSIVE PANEL
WBC, Hgb, MCV, MCHC, RDW, MPV, Gran%, MONO%, EOS%, BASO%, ANC, MONO#, EOS#, BASO#
GLUCOSE, BUN, CREAT, BUN/CREAT RATIO, GFR, SODIUM, POTASSIUM, CHLORIDE, CALCIUM, TOTAL PROTEIN, ALBUMIN, GLOBULIN, A/G, ALK PHOS, TOTAL BILI, ALT, AST
ERYTHROCYTE SEDIMENTATION RATE
FERRITIN
FOLATE
HIGH-SENSITIVITY C-REACTIVE PROTEIN
HIV Ag/AB WITH REFLEX
IMMUNOELECTROPHORESIS (IFE)
IRON, TIBC, UIBC, %SAT
LDH
MAGNESIUM, PHOSPHORUS
RHEUMATIOD FACTOR
SERUM PROTEIN ELECTROPHORESIS
TSH
VITAMIN B-12
EGFR
ANION GAP
ALBUMIN
BILIRUBIN TOTAL
BILIRUBIN CONJUGATED
ALKALINE PHOSPHATASE
ALANINE AMINOTRANSFERASE
ASPARTATE AMINOTRANSFERASE
TOTAL PROTEIN
HEPATITIS B
HEPATITIS C
HEP B CORE ANTIBODY
OTHER TESTING PERFORMED WITH RESULTS:
FLOW CYTOMETRY ANALYSIS:
DIAGNOSIS – “NO DIAGNOSTIC IMMUNOPHENOTYPIC ABNORMALITIES DETECTED.”
LYMPHOCYTES: 10.1% - T- CELLS (77% OF LYMPHOID CELLS) SHOW A CD4/CD8 RATIO OF ABOUT 3.9 WITHOUT OVERT PHENOTYPIC ABNORMALITY. NK- CELLS (9% OF LYMPHOID CELLS) ARE UNREMARKABLE. MATURE B-CELLS (3% OF LYMPHOID CELLS ARE POLYCLONAL (KAPPA:LAMDA 2.2)
MONOCYTES: 3% - MONOCYTES CO-EXPRESS CD14 AND CD64 WITHOUT PHENOTYPIC ABNORMALITIES
GRANULOCYTES: 83.1% - GRANULOCYTES ARE PHENOTYPICALLY MATURE AND WITHOUT ABERRANT ANTIGEN EXPRESSION
CD45 DIM: 0% - CD34+ CELLS ARE NOT DETECTED
MARKERS PERFORMED: CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD11c, CD13, CD14, CD16, CD19, CD20, CD23, CD33, CD34, CD38, CD45, CD56, CD64, CD117, HLA-DR, KAPPA, LAMDA (24 MARKERS)
CT SCAN OF ABDOMEN ANALYSIS:
IMPRESSION: * Marked splenomegaly with spleen measuring 15.9 x 9.8 x 20.6 cm. 6.9 times the upper limits of normal in volume, based on the calculation of the splenic index. * No abdominal or pelvic lymphadenopathy.
CLINICAL INDICATION: new onset splenomeagly r/o lymphoma :: R16.1 Splenomegaly, not elsewhere classified
TECHNIQUE: CT abdomen and pelvis with intravenous contrast. Intravenous contrast: IOPAMIDOL 61 % INTRAVENOUS SOLUTION: 100 mL. COMPARISON: None.
INTERPRETATION: SCOUT: No additional findings.
LUNG BASES/PLEURA: Within normal limits.
HEART: The heart is normal in size.
LIVER: Within normal limits.
BILIARY SYSTEM: There is no biliary ductal dilatation.
GALLBLADDER: No radiopaque gallstones.
PANCREAS: Within normal limits.
SPLEEN: There is marked splenomegaly with spleen measuring 15.9 x 9.8 x 20.6 cm. 6.9 times the upper limits of normal in volume, based on the calculation of the splenic index
ADRENALS: Within normal limits.
KIDNEYS/URETERS: No hydronephrosis or obstructing stones. There is a 3.8 cm cyst in the left lower pole.
BOWEL/MESENTERY: No bowel obstruction or wall thickening. The appendix is normal.
URINARY BLADDER: Underdistended, limiting evaluation.
REPRODUCTIVE ORGANS: No pelvic masses. The prostate and seminal vesicles are within normal limits.
PERITONEUM/RETROPERITONEU M: No free air. No free or loculated fluid.
LYMPH NODES: No abdominal or pelvic lymphadenopathy.
VESSELS: No abdominal aortic aneurysm.
BONES: Within normal limits.
SOFT TISSUES: There is a small fat containing umbilical hernia
CT SCAN OF CHEST ANALYSIS:
CLINICAL INFORMATION: Splenomegaly. Possible mediastinal lymphadenopathy.
TECHNIQUE: Routine scan with contiguous axial images acquired from the thoracic inlet to the upper abdomen after administration of intravenous contrast. Post processed reconstructions acquired and reviewed.
CONTRAST: 100 cc of nonionic intravenous contrast at a concentration of 300 mg/mL.
COMPARISON: NONE. FINDINGS: BASE OF NECK: No discrete nodule within the thyroid gland.
LUNGS/PLEURA: No focal consolidation. No pleural effusion or pneumothorax. There is biapical nodularity likely secondary to scarring.
NODULES: Right lung: 3 mm nodule in the right upper lobe (image 93, series 4). 2 mm pleural-based nodule in the right upper lobe (image 131, series 4) which may represent a calcified granuloma. Punctate nodule in the right middle lobe (image 159, series 4). 4 mm nodule in the right middle lobe (image 202, series 4). 2 mm nodlue in the right middle lobe (image 216, series 4). 3 mm nodule within the right lower lobe (image 218, series 4). 2 mm nodule in the right lower lobe (image 166, series 4) abutting the fissure. Left lung: 2 mm nodule in the left upper lobe abutting the fissure (image 166, series 4). 3 mm nodule within the left lower lobe abutting the fissure (image 219, series 4).
LARGE AIRWAYS: Patent. HEART: Within normal limits for size.No pericardial effusion.
VESSELS: No aneurysm of thoracic aorta. Atherosclerotic disease involving the thoracic aorta.
MEDIASTINUM and HILA: Nonspecific 1.3 x 1.4 cm right hilar lymph node. Subcentimeter left hilar lymph node. Subcentimeter mediastinal lymph nodes. There is soft tissue within the anterior superior mediastinum which may represent residual/rebound thymus with associated subcentimeter calcification.
AXILLAE: Subcentimeter axillary lymph nodes.
IMAGED UPPER ABDOMEN: The spleen is enlarged. BONY THORAX/SOFT TISSUES: Degenerative changes of thoracic spine. There is bilateral gynecomastia.
IMPRESSION: 1. Multiple subcentimeter pulmonary nodules with the largest measuring 4 mm as well as a nonspecific enlarged right hilar lymph node measuring up to 1.4 cm. 6-12 month follow-up is recommended. 2. Splenomegaly.
BLOOD TESTING RESULTS:
ABNORMAL TEST RESULTS:
BETA 2 MICROGLOBULIN: 2.5 (HIGH) – NORMAL RANGE: 0.8 – 2.2
RBC: 4.22 (LOW) – NR: 4.5 – 6.5
HCT: 39.4 (LOW) – NR: 40 – 54
MCH: 33.2 (HIGH) – NR: 27 – 32
PLAT: 74 (LOW) – NR: 150 -500
LYMPH%: 18.1 (LOW) – NR: 20.5 – 51.1
LYMPH#: 0.9 (LOW) – NR: 1.2 – 3.4
F KAPPA LT CHAIN 20.2 (HIGH) – NR 3.3 – 19.4
CO2: 21 (LOW) – NR: 22 – 29
CORRECTED SERUM CALCIUM: 8.4 (LOW) – NR: 8.6 – 10
FIBRINOGEN ACTIV, CLAUSS: 128 (LOW) – NR: 193 – 507
HAPTOGLOBIN: 24 (LOW) – NR: 30 – 200
PLATELET, BLUE TOP: 67 (LOW) – NR: 150 – 500
PROTIME: 12.2 (HIGH) – NR: 9.1 – 12
INR: 1.2 (HIGH) – NR: 0.8 – 1.1
URIC ACID: 8.0 (HIGH) – NR: 3.4 – 7
DIRECT ANTIGLOBULIN (DAT): POSITIVE
NORMAL TEST RESULTS:
IgA, IgM, IgG (Quiggs)
F LAMDA LT CHAIN
KAPPA LAMBDA RATIO
ANA COMPREHENSIVE PANEL
WBC, Hgb, MCV, MCHC, RDW, MPV, Gran%, MONO%, EOS%, BASO%, ANC, MONO#, EOS#, BASO#
GLUCOSE, BUN, CREAT, BUN/CREAT RATIO, GFR, SODIUM, POTASSIUM, CHLORIDE, CALCIUM, TOTAL PROTEIN, ALBUMIN, GLOBULIN, A/G, ALK PHOS, TOTAL BILI, ALT, AST
ERYTHROCYTE SEDIMENTATION RATE
FERRITIN
FOLATE
HIGH-SENSITIVITY C-REACTIVE PROTEIN
HIV Ag/AB WITH REFLEX
IMMUNOELECTROPHORESIS (IFE)
IRON, TIBC, UIBC, %SAT
LDH
MAGNESIUM, PHOSPHORUS
RHEUMATIOD FACTOR
SERUM PROTEIN ELECTROPHORESIS
TSH
VITAMIN B-12
EGFR
ANION GAP
ALBUMIN
BILIRUBIN TOTAL
BILIRUBIN CONJUGATED
ALKALINE PHOSPHATASE
ALANINE AMINOTRANSFERASE
ASPARTATE AMINOTRANSFERASE
TOTAL PROTEIN
HEPATITIS B
HEPATITIS C
HEP B CORE ANTIBODY
OTHER TESTING PERFORMED WITH RESULTS:
FLOW CYTOMETRY ANALYSIS:
DIAGNOSIS – “NO DIAGNOSTIC IMMUNOPHENOTYPIC ABNORMALITIES DETECTED.”
LYMPHOCYTES: 10.1% - T- CELLS (77% OF LYMPHOID CELLS) SHOW A CD4/CD8 RATIO OF ABOUT 3.9 WITHOUT OVERT PHENOTYPIC ABNORMALITY. NK- CELLS (9% OF LYMPHOID CELLS) ARE UNREMARKABLE. MATURE B-CELLS (3% OF LYMPHOID CELLS ARE POLYCLONAL (KAPPA:LAMDA 2.2)
MONOCYTES: 3% - MONOCYTES CO-EXPRESS CD14 AND CD64 WITHOUT PHENOTYPIC ABNORMALITIES
GRANULOCYTES: 83.1% - GRANULOCYTES ARE PHENOTYPICALLY MATURE AND WITHOUT ABERRANT ANTIGEN EXPRESSION
CD45 DIM: 0% - CD34+ CELLS ARE NOT DETECTED
MARKERS PERFORMED: CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD11c, CD13, CD14, CD16, CD19, CD20, CD23, CD33, CD34, CD38, CD45, CD56, CD64, CD117, HLA-DR, KAPPA, LAMDA (24 MARKERS)
CT SCAN OF ABDOMEN ANALYSIS:
IMPRESSION: * Marked splenomegaly with spleen measuring 15.9 x 9.8 x 20.6 cm. 6.9 times the upper limits of normal in volume, based on the calculation of the splenic index. * No abdominal or pelvic lymphadenopathy.
CLINICAL INDICATION: new onset splenomeagly r/o lymphoma :: R16.1 Splenomegaly, not elsewhere classified
TECHNIQUE: CT abdomen and pelvis with intravenous contrast. Intravenous contrast: IOPAMIDOL 61 % INTRAVENOUS SOLUTION: 100 mL. COMPARISON: None.
INTERPRETATION: SCOUT: No additional findings.
LUNG BASES/PLEURA: Within normal limits.
HEART: The heart is normal in size.
LIVER: Within normal limits.
BILIARY SYSTEM: There is no biliary ductal dilatation.
GALLBLADDER: No radiopaque gallstones.
PANCREAS: Within normal limits.
SPLEEN: There is marked splenomegaly with spleen measuring 15.9 x 9.8 x 20.6 cm. 6.9 times the upper limits of normal in volume, based on the calculation of the splenic index
ADRENALS: Within normal limits.
KIDNEYS/URETERS: No hydronephrosis or obstructing stones. There is a 3.8 cm cyst in the left lower pole.
BOWEL/MESENTERY: No bowel obstruction or wall thickening. The appendix is normal.
URINARY BLADDER: Underdistended, limiting evaluation.
REPRODUCTIVE ORGANS: No pelvic masses. The prostate and seminal vesicles are within normal limits.
PERITONEUM/RETROPERITONEU M: No free air. No free or loculated fluid.
LYMPH NODES: No abdominal or pelvic lymphadenopathy.
VESSELS: No abdominal aortic aneurysm.
BONES: Within normal limits.
SOFT TISSUES: There is a small fat containing umbilical hernia
CT SCAN OF CHEST ANALYSIS:
CLINICAL INFORMATION: Splenomegaly. Possible mediastinal lymphadenopathy.
TECHNIQUE: Routine scan with contiguous axial images acquired from the thoracic inlet to the upper abdomen after administration of intravenous contrast. Post processed reconstructions acquired and reviewed.
CONTRAST: 100 cc of nonionic intravenous contrast at a concentration of 300 mg/mL.
COMPARISON: NONE. FINDINGS: BASE OF NECK: No discrete nodule within the thyroid gland.
LUNGS/PLEURA: No focal consolidation. No pleural effusion or pneumothorax. There is biapical nodularity likely secondary to scarring.
NODULES: Right lung: 3 mm nodule in the right upper lobe (image 93, series 4). 2 mm pleural-based nodule in the right upper lobe (image 131, series 4) which may represent a calcified granuloma. Punctate nodule in the right middle lobe (image 159, series 4). 4 mm nodule in the right middle lobe (image 202, series 4). 2 mm nodlue in the right middle lobe (image 216, series 4). 3 mm nodule within the right lower lobe (image 218, series 4). 2 mm nodule in the right lower lobe (image 166, series 4) abutting the fissure. Left lung: 2 mm nodule in the left upper lobe abutting the fissure (image 166, series 4). 3 mm nodule within the left lower lobe abutting the fissure (image 219, series 4).
LARGE AIRWAYS: Patent. HEART: Within normal limits for size.No pericardial effusion.
VESSELS: No aneurysm of thoracic aorta. Atherosclerotic disease involving the thoracic aorta.
MEDIASTINUM and HILA: Nonspecific 1.3 x 1.4 cm right hilar lymph node. Subcentimeter left hilar lymph node. Subcentimeter mediastinal lymph nodes. There is soft tissue within the anterior superior mediastinum which may represent residual/rebound thymus with associated subcentimeter calcification.
AXILLAE: Subcentimeter axillary lymph nodes.
IMAGED UPPER ABDOMEN: The spleen is enlarged. BONY THORAX/SOFT TISSUES: Degenerative changes of thoracic spine. There is bilateral gynecomastia.
IMPRESSION: 1. Multiple subcentimeter pulmonary nodules with the largest measuring 4 mm as well as a nonspecific enlarged right hilar lymph node measuring up to 1.4 cm. 6-12 month follow-up is recommended. 2. Splenomegaly.
Brief Answer:
Probably autoimmune problem
Detailed Answer:
Hi
Thanks for your query.
The significant findings which I could find are- spleen enlarged, DAT+ and platelets low.
These suggest that some autoimmune problem is going on whereby the body's immunity is attacking the platelets. To confirm this, a bone marrow exam should be done which usually shows good production of platelets in marrow. That suggests destruction by antibodies.
Lung nodules are too small and needs followup only. There is no evidence of lymphoma till now. Bone marrow should help in ruling it out.
Once established, this can be treated appropriately.
Hope this helps.
Regards
Probably autoimmune problem
Detailed Answer:
Hi
Thanks for your query.
The significant findings which I could find are- spleen enlarged, DAT+ and platelets low.
These suggest that some autoimmune problem is going on whereby the body's immunity is attacking the platelets. To confirm this, a bone marrow exam should be done which usually shows good production of platelets in marrow. That suggests destruction by antibodies.
Lung nodules are too small and needs followup only. There is no evidence of lymphoma till now. Bone marrow should help in ruling it out.
Once established, this can be treated appropriately.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thx - some follow up questions:
What is DAT+? Is there a treatment for it?
Is it safe to say that i do not have leukemia or myeloma?
What other infection may be causing the enlarged spleen? Have I been tested for all of them?? Can someone have an enlarged spleen for no reason? Mine has been enlarged for over 10 years.
Regards
What is DAT+? Is there a treatment for it?
Is it safe to say that i do not have leukemia or myeloma?
What other infection may be causing the enlarged spleen? Have I been tested for all of them?? Can someone have an enlarged spleen for no reason? Mine has been enlarged for over 10 years.
Regards
Brief Answer:
Direct antiglobulin means autoimmune reaction
Detailed Answer:
It suggests body's own antibodies attacking body cells. Spleen is often enlarged because it's a site of antibody production.
Many treatment options are available like steroids, rituximab, intravenous gammaglobulin, etc. Most of the infections causing enlarged spleen have been ruled out.
There's no evidence of lymphoma or myeloma till now but bone marrow is definitely required.
Regards
Direct antiglobulin means autoimmune reaction
Detailed Answer:
It suggests body's own antibodies attacking body cells. Spleen is often enlarged because it's a site of antibody production.
Many treatment options are available like steroids, rituximab, intravenous gammaglobulin, etc. Most of the infections causing enlarged spleen have been ruled out.
There's no evidence of lymphoma or myeloma till now but bone marrow is definitely required.
Regards
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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