Barbara J. Bain
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Peripheral Blood Lymphocytosis Reflecting an Underlying Thymoma
A 36-year-old man with well-controlled asymptomatic myasthenia gravis presented for a biopsy of a 9 cm unresectable anterior mediastinal mass infiltrating the aortopulmonary window (top left, computed tomography). A blood count showed lymphocytosis (lymphocyte count 5.7 × 109/L) and microcytosis without anemia (mean cell volume 74.5 fl), hemoglobin concentration 148 g/L (the patient was known to have α thalassemia trait).
Striking Bone Marrow Plasmacytosis Resulting From Visceral Leishmaniasis
A 57-year-old UK national presenting to the emergency department following a fall revealed a history of 4 months of progressive constitutional symptoms: weight loss, recent ear infection, and intermittent epistaxis. He had resided in Spain from 2021 until returning to the UK 6 months before this presentation. On examination, he had cervical, axillary, and inguinal lymphadenopathy without palpable hepatosplenomegaly.
Can We Really Believe This Platelet Count?
A 64-year-old woman presented to the hematology clinic for follow up of refractory chronic cold agglutinin disease with hepatic iron overload secondary to a chronic red cell transfusion burden. Management had included single-agent rituximab and ciclosporin, to which the disease had proven refractory. She had recently received a first cycle of bendamustine and rituximab. On review preceding a second cycle, she was tired and lightheaded and scleral icterus was noted.
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