Complete Blood Count + Peripheral Smear
WBC/DC: 12,900 /mm3 (4,500-10,500)
Lymphocytes: 9,900 /mm3
Hb: 10.3 g/dL (10.5-18)
Hct: 37% (36-44)
RBC: 4.1x10^6/ml (4.0-4.9)
Platelets: 82x10^3/mL (150-450x10^3)
The peripheral smear shows rouleaux formation, with atypical lymphocytes and plasmacytoid cells.
Total Bilirubin: 1.1 mg/dL (0.1-1.2)
AST: 38 U/L (<35)
ALT: 37U/L (<35)
ALP: 142 U/L (33-131)
GGT: 78 U/L (0-51)
Total Protein: 9.3 g/dL (6.0-8.3)
Albumin: 2.9 g/dL (3.2-5.0)
INR: 1.2 (0.8-1.1)
LDH: 315 U/L (56-194)
Bone Marrow Aspiration + Biopsy
The bone marrow aspirate reveals a population of small, atypical lymphocytes admixed with normal cells.
H&E staining of the trephine biopsy specimen demonstrates large intratrabecular lymphoid aggregates; immunostaining reveals the lymphiod cells to be CD20 positive and CD10 negative.
Flow cytometry shows 77% of the lymphoid cells to be CD19, CD20, CD79b and cytoplasmic kappa positive, and negative for CD5, CD10, CD38 and CD138.
Serum Protein Electrophoresis
Serum electrophoresis reveals a large IgM component (>30 g/L), along with a a mild increase in serum IgG concentrations. Immunofixation reveals a monoclonal band which fixes anti-IgM and anti-kappa.
Bence-Jones proteins are not detected.