This week’s case features a 27 year old male patient whose routine monitoring sample arrived in the laboratory in the early hours of the morning. The sheer volume of white blood cells completely overwhelmed the automated analyser, causing it to fail to output a standard automated differential count.

The patient presented with a acute history of swollen, bleeding gums (gingival hypertrophy), a persistent sore throat, and a high fever that failed to respond to standard antibiotics. On physical examination, mild hepatosplenomegaly and distinct cutaneous skin lesions were noted.

FBC Results:

• WBC: 132.73 x 10⁹/L
• RBC: 3.02 x 10¹²/L
• MCV: 98.3 fL
• PLT: 236 x 10⁹/L

A blood film was made to review the results and perform a manual differential count.

Though the automated platelet count was normal, this was not reflected on the blood film. What could be going on and what do you think is the final diagnosis?

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