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Weakness, DOE, and WBC > 100K: What's Your Diagnosis?

Weakness, DOE, and WBC > 100K: What's Your Diagnosis?

A 75-year-old man with a past medical history of hypertension presents to the emergency department complaining of 2 weeks of gradually worsening generalized weakness and dyspnea on exertion. He denies any cough, fever, chest pain, or other complaints.

Examination: Vital signs: BP: 112/73 mm Hg, HR: 118 beats/min, RR: 28 breaths/min; O2 Sat 98% on room air.

Other than tachycardia and tachypnea, the remainder of the physical examination was essentially normal.

Testing:

Chest X-ray: Mild pulmonary vascular congestion.

CBC: WBC 192,000 with 7% blasts, hemoglobin 8.8, platelets 90

Chemistry: K 5.8, Na 128, Cr 2.6, Phos 5.7, Uric acid 19.7, Lactic acid 13.5

 

 

Questions:
1. What is the most likely diagnosis? Is more than one diagnosis likely?

2. What should you do to properly manage this patient?  

3. What is this patient's prognosis?

Please click here for answer and discussion.

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