Postscript

The patient has been followed for the past year. She has developed occasional mouth ulcers and she has had 2 sinusitis infections, which were treated with antibiotics. Otherwise she has done well. Her absolute neutrophil counts (ANC) have varied somewhat, but not in a cyclical manner. The following are some of her results over time.

DateWBC (109/L)ANC (109/L)
1 year later2.60.52
3 months later2.90.23
1 month later3.30.63
7 days later2.50.44
3 days later3.71.28
Day you saw the patient3.40.97

What’s what: WBC, white blood cell count; Hb, hemoglobin; MCV, mean cell volume; MCHC, mean cellular hemoglobin concentration; RDW-SD, red cell distribution width-standard deviation; platelets, PLT; Normal values: WBC 5-10 x 109/L, RBC 4-6 x 1012/L, Hb 12-16 g/dL, Hct 35-47%, MCV 80-100 fL, MCHC 32-36 g/dL, RDW-SD < 45%, platelets (PLT) 150-450 x 109/L