A 50 year old women with possible multifactorial disease.

1.

Obstructive jaundice – Cholecystitis, ascending Cholangitis

Pancreatitis – ??gallstone Pancreatitis

significantly high WCC with predominant Lymphocytosis

2. Haematologic abnormalities:

Isolated elevation in WCC with normal Hb and Platelets (unlikely to be bone marrow failure)

Neutrophillia due to infection (as above)

Causes of Lymphocytosis –

– Infection – viral (EBV, CMV, HIV), atypicals (TB)

– Malignancy – Lymphoma, ALL, CLL, Multiple Myeloma

3. Criteria for urgent haematology referral in setting of Lymphocytosis:

– Hb < 100 and/or Platelets <100

– B symptoms – >10% weight loss in previous 6 months, severe night sweats, unexplained fever >38 for >2 weeks

– Lymphadenopathy

– Hepatomegaly, Splenomegaly or both

– Extreme fatigue