A 21 year old male fainted suddenly after a party. Please guide us.

Question

Hello doctor,

This query is regarding a 21-year-old male having no health complications in the past who suddenly fainted after a party. We took him to our GP for a check-up. The GP found nothing wrong and advised rest. However, we went to the lab on our own and carried out CBC. WBC count was high in the first report - 11,300, lymphocytes 4,500, and RDW 16 which was indicated as high in the report.

The peripheral smear showed:

RBC: Normocytic normochromic with mild anisocytosis.

WBC: Absolute lymphocytic leukocytosis.

Platelets: Adequate.

We then went for one more blood test in the following week. This time the WBC was 7100 and lymphocytes 5100.

The morphology report says:

RBC: normocytic normochromic.
WBC: within normal limits.
Platelets: adequate on smear.
Impression: normal peripheral smear.
No hemoparasites were seen.

The boy has lost some weight. A mild night sweat is there. Please guide us.

Answer 1

Hello,

Welcome to icliniq.com.

The diagnosis in your case is lymphocytosis. The underlying cause for the lymphocytosis should be searched for. For that, a detailed physical examination should be done and liver, spleen and lymph nodes should be palpated. Infectious mononucleosis, viral influenza, hepatitis, lymphoproliferative disorders, syphilis, etc., are some of the causes.

If any specific clinical complaint is present than provide history regarding that for further discussion.

You investigate further according to need like influenza antibody testing, SGPT and SGOT, HIV testing, etc. Your peripheral smear examination reports are normal and are not showing any specific abnormal cells. You have to repeat CBC (complete blood count) again after a week.

If lymphocytosis persists for more than three to four weeks then flow cytometry investigation should be done to rule out monoclonal nature of lesion.

Answer 2

Hello,

Welcome back to icliniq.com.

Liver, spleen and lymph nodes palpation can be done by a general practitioner or physician. A physician would be the best doctor to consult in comparison to a general practitioner for a physical examination.

If no reactive cause for lymphocytosis is found, flow cytometry can be done to rule out monoclonal nature of the lesion. The monoclonal nature could be in the form of monoclonal B cell lymphocytosis or chronic lymphoid leukemia. The reactive lymphocytosis is polyclonal and not monoclonal that can be decided by flow cytometry. But practically speaking, at normal or low WBC count, a chance of reactive lymphocytosis is more as compared to leukemia or monoclonal B cell lymphocytosis. So, consult physician or hematologist for examination and if no specific secondary causes are found (like influenza, hepatitis, infectious mononucleosis, tuberculosis) than repeat CBC after a few days and if lymphocytosis is persistent then flow cytometry can be done.