Question

An elderly male went for a medical examination. Laboratory investigations showed a marked elevation of lymphocytes with marked leukocytosis. The peripheral smear of the patient is given below. What is the appropriate next step for this patient?

• A. Stem cell transplantation
• B. Bone marrow biopsy
• C. Flow cytometry
• D. Start high-dose chemotherapy

Answer 1

The Correct Option is C

In evaluating an elderly male with elevated lymphocytes and significant leukocytosis, one must determine the underlying cause of these findings. The peripheral blood smear is instrumental in aiding this evaluation, typically showing features that suggest a specific diagnosis.

The options include: Stem cell transplantation, Bone marrow biopsy, Flow cytometry, and Start high-dose chemotherapy.

To decide the appropriate next step, consider:

1. Flow Cytometry: This test is particularly useful for immunophenotyping, which helps in classifying types of leukemia or lymphomas by identifying specific markers on the cell surface. In cases of lymphocytosis and leukocytosis, this is the best next step to confirm the presence and specific type of a hematological malignancy such as Chronic Lymphocytic Leukemia (CLL).

2. Bone Marrow Biopsy: This invasive procedure provides detailed information on bone marrow architecture and cellular composition. However, it is usually performed after initial tests indicate a problem, such as the results obtainable from flow cytometry.

3. Start High-Dose Chemotherapy: This is a treatment step for managing hematological malignancies, not an initial diagnostic step.

4. Stem Cell Transplantation: Like chemotherapy, this is a treatment step considered in the management of certain malignancies, not as an initial diagnostic approach.

Given these considerations, the appropriate next step is Flow Cytometry to further investigate the characteristics of the elevated lymphocytes and identify any specific clonal population suggestive of leukemia.