Table 1.
The lab findings showed a drastic increase in the number of WBCs (97,610
cells /cumm) along with derangements in PCV, MCV, ESR/CRP, RBC count,
platelet count and abnormal iron studies. Electrolytes measurement
showed hypokalemia with typical ECG features [Fig. 3.].Ultrasonography showed splenomegaly of size 15cm. The patient was then
admitted to the medicine ICU where the serial CBC and electrolytes
monitoring was done the results of which are tabulated in Table
2. The peripheral smear performed on the day of admission showed 97,600
cell counts with 36% hyper-segmented neutrophils, 14% band cells, 10%
promyelocytes, 20% myelocytes, 8% metamyelomyelocytes, 8%
lymphocytes, 4% basophil with microcytic hypochromic anemia and
anisocytosis with giant platelets likely thrombocytosis and left shift
suggestive of leukemoid reaction [Fig.4.] . The patient had
total 3 spikes fever for 2 days post admission, with max documented
temperature of 102.2 F. No source of infection was clinically
identified. Tests for infective etiology like Scrub typhus, dengue
fever, and malaria tests reported negative. Blood culture, high vaginal
swab and urine culture did not show growth of any organisms after 48
hours. At ICU, she received 2 pints whole blood transfusion and was
managed with injectible antibiotics for covering post-operative sepsis.
Since 4th day of admission, she started complaining of
a burning sensation in her hands and feet and headache, following which
Inj Clexane was prescribed. Other signs of hyperviscosity syndromes were
absent. The patient was under constant monitoring for signs of
hyperviscosity and was mobilized. On the 5thDOA, the lab parameters showed hemoglobin of 7.6 gm/dl, WBC count - of
1,66,690 cells/cumm and platelet count of 1,111,000 cells/cumm, thus in
order to rule out leukaemia, bone marrow aspiration was planned. Fluid
intake was increased. The patient was under further management but due
to some financial problems, the patient’s caregivers requested discharge
against medical advice. She was advised to follow-up.