Peripheral Blood and Bone Marrow / Case 1  The patient is a 64 year-old male who presents with fatigue, Coombs positive hemolytic anemia, mild increase in indirect bilirubin, mild hepatosplenomegaly and axillary lymphadenopathy. The followings are representative data and images:

Peripheral blood smear

Bone marrow smear

Peripheral Blood CBC

Hb

8.8 grams

WBC

25,000, 60% Lymphocytes

Platelets

124,000

Peripheral Blood Phenotyping

Surface IgM/IgD

Dim

CD19

+

CD20

Weak

CD22

Weak

CD23

+

CD11c

Weak

CD5

+

FMC7

+

What is your diagnosis?

A Circulating mantle cell lymphoma

B Chronic lymphocytic leukemia.

C Hairy cell leukemia.

D Acute lymphocytosis.