Our practice is dedicated to helping people with rheumatoid arthritis (RA), osteoporosis, autoimmune diseases and other musculoskeletal conditions. We perform over 150,000 lab tests annually in Chemistry, Urinalysis, Hematology and Immunology. Even though we’re not specialized in areas like Hematology or Oncology, our lab recently made an impact in a patient’s early diagnosis of Chronic MyeloMonocytic Leukemia (CCML).
Back in 2010, this patient, a 65-year old male, had had a bone marrow performed. He had a history of “paraproteinemia,” an excess of proteins in the blood, a condition which can either be benign or associated with multiple myeloma. His was considered “silent” or benign.
When he was diagnosed with RA in 2013, we began conducting Complete Blood Count tests on him. From 2013 through 2014, his white blood cell count (WBC) ranged from 5.3 to 7.5, with no abnormalities noted. A follow up visit to his oncologist in February, 2015 also showed no abnormal WBC, with his diagnosis still remaining RA and silent paraproteinemia.
But beginning this past May, we began to see evidence of his WBC shooting up, first to 18.9, then to 26.0 in July, then back to 20.9 in August. When it hit 26.0, triggering a manual differential test, the technologist observed that there were very slight variations in the normal numbers of the different types of white and red blood cells and macro platelets. The tech consulted with the Lab Manager, and they decided to send the slide to our Pathologist for a consult. At this point, it seemed to all the techs that had been performing his CBCs and other tests over the years that his WBC was becoming more elevated with the passage of time, and that the percentages of the different cells on his differential were becoming more abnormal – even though these changes were very slight.
Several days later, we received the pathologist’s report, which indicated that some myeloid malignancies were present in addition to some rare blast cells. Further testing resulted in the CCML diagnosis in August, and treatment was immediately started. I believe our lab team’s vigilance – particularly given the very slight differences they were noticing in the percentages of his cells — made all the difference in getting this patient the treatment he needed, when he needed it most.