Published 10 June 2009, doi:10.1136/bmj.b2119
Cite this as: BMJ 2009;338:b2119

Practice

Rational Testing

Incidental finding of lymphocytosis in an asymptomatic patient

¹ Haematology Department, Addenbrooke’s Hospital, Cambridge CB2 0QQ

What tests are needed when an asymptomatic patient presents with lymphocytosis?

The first 150 words of the full text of this article appear below.

A 63 year old asymptomatic man presented for health assessment. He had no medical history and was not taking any drugs. No abnormality was found on physical examination. A blood count showed haemoglobin 126 g/l (normal range 130-180 g/l), mean corpuscular volume 87 fl (80-100 fl), platelets 160x10⁹/l (150-400x10⁹/l), and leucocytes 13.1x10⁹/l (4-13x10⁹/l) with a neutrophil count of 5.4x10⁹/l (2-8x10⁹/l) and lymphocytes 8.0x10⁹/l (1-4x10⁹/l). Blood film showed lymphocytosis, with small mature lymphocytes and "smear" cells. The red cells were normochromic and normocytic, and the platelets appeared normal.

The reporting haematologist recommended a repeat blood count and film in 2-4 weeks. This showed persistence of mild normocytic anaemia (haemoglobin 128 g/l) and lymphocytosis (8.2x10⁹/l) of small mature lymphocytes and smear cells.

As the mild . . . [Full text of this article]

Reactive (secondary) lymphocytosis
Normal morphology
Atypical morphology
Neoplastic (primary) lymphocytosis

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Rapid Responses:

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Incidental lymphocytosis

Terry J Hamblin
bmj.com, 4 Jul 2009 [Full text]

Re: Incidental lymphocytosis

Edward Fitzsimons, et al.
bmj.com, 6 Jul 2009 [Full text]

Authors' Response to Dr Hamblin

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Incidental lymphocytosis is not always incidental

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