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From this report give dd
The Differential Leucocyte Count (DLC) from this CBC report is:
| Cell Type | Result | Unit | Reference Range |
|---|---|---|---|
| Neutrophils | 57.9 | % | 40-80 |
| Lymphocytes | 36.4 | % | 20-40 |
| Monocytes | 5.7 | % | 0-10 |
Absolute Counts:
| Cell Type | Result | Unit | Reference Range |
|---|---|---|---|
| Lymphocytes | 3.7856 H (High) | x10^3/uL | 1.0-3.0 |
| Monocytes | 0.5928 | x10^3/uL | 0.2-1 |
| NLR | 0 | - | 0-3 |
Notable finding: Absolute Lymphocyte count is elevated at 3.7856 x10^3/uL (above the upper limit of 3.0). All percentage-based differential counts are within normal range.
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Based on the CBC findings and authoritative textbook sources, here is the differential diagnosis:
Differential Diagnosis
Key CBC Abnormalities to Explain:
- Absolute lymphocytosis (3.79, High)
- Thrombocytopenia (Platelets 100, Low)
- Mild leukocytosis (WBC 10.4)
- Elevated PDW (20.5)
- Patient: 28M
1. Infectious Mononucleosis (EBV) - MOST LIKELY
The combination of absolute lymphocytosis + thrombocytopenia in a young adult is classic for EBV infection. As noted in Dermatology 5e: "Laboratory findings include mild thrombocytopenia and an absolute and relative lymphocytosis with 20-40% atypical lymphocytes." Fitzpatrick's Dermatology confirms EBV complications include "autoimmune hemolytic anemia or thrombocytopenia."
- Look for: Fever, sore throat, posterior cervical lymphadenopathy, splenomegaly, fatigue
- Confirm with: Monospot test, EBV VCA IgM, peripheral smear (atypical lymphocytes)
2. Dengue Fever
Dengue classically causes thrombocytopenia + relative lymphocytosis. It is highly prevalent in India (Odisha, Jajpur district) and common in young males.
- Look for: High fever, retro-orbital headache, myalgia, rash, recent mosquito exposure
- Confirm with: NS1 antigen, Dengue IgM/IgG serology
3. CMV (Cytomegalovirus) Infection
Harrison's Principles (22E) states: "Liver function abnormalities, leukopenia, thrombocytopenia, and atypical lymphocytosis may be observed during CMV infection episodes."
- Look for: Prolonged fever, malaise, mild hepatitis, pharyngitis (milder than EBV)
- Confirm with: CMV IgM, CMV PCR
4. Immune Thrombocytopenic Purpura (ITP) - Secondary
Could coexist with a viral illness driving both lymphocytosis and immune-mediated platelet destruction.
- Look for: Petechiae, purpura, easy bruising, mucosal bleeding
- Confirm with: Peripheral smear, bone marrow biopsy if needed, exclude secondary causes
5. Malaria
Common in Odisha/Jajpur. Can cause thrombocytopenia and reactive lymphocytosis.
- Look for: Cyclical fever, chills, rigors, hepatosplenomegaly
- Confirm with: Peripheral smear (thick and thin), Rapid Diagnostic Test (RDT)
6. Viral Hepatitis (Hepatitis A, B, E)
Acute viral hepatitis can produce lymphocytosis and thrombocytopenia.
- Look for: Jaundice, right upper quadrant pain, dark urine, nausea
- Confirm with: LFTs, HBsAg, Anti-HAV IgM, Anti-HEV IgM
7. HIV / Acute Retroviral Syndrome
Primary HIV infection can cause lymphocytosis and thrombocytopenia in a young male.
- Look for: Flu-like illness, rash, oral ulcers, high-risk behavior history
- Confirm with: HIV 4th generation Ag/Ab combo test
Suggested Workup Priority
| Test | Reason |
|---|---|
| Peripheral blood smear | Look for atypical lymphocytes, malarial parasites |
| Monospot / EBV VCA IgM | Rule out Infectious Mononucleosis |
| Dengue NS1 Ag + IgM/IgG | Rule out Dengue (endemic region) |
| Malaria RDT / smear | Endemic area |
| LFTs | Assess hepatic involvement |
| HIV Ag/Ab (4th gen) | Young male, thrombocytopenia |
| CMV IgM | If EBV negative |
Note: A peripheral blood smear is the single most important next step - it can show atypical lymphocytes (EBV/CMV), malarial parasites, or platelet morphology clues.
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