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Question 3 of 3 – What is your next step?

Pathological analysis of biopsy samples from the enlarged subclavicular lymph node and the bone marrow was performed. The results were consistent with the finding of lymphocytosis in the peripheral blood sample. The cells in the lymph node displayed features of chronic lymphocytic leukemia (CLL) and immunoglobulin heavy chain variable region gene (IGHV).

After four cycles of plasmapheresis, the hemolysis and thrombocytopenia resolved promptly. The patient’s renal function improved, but she still experienced massive proteinuria.

Results of peripheral blood cell analysis:

WBC: 9.72 X 10⁹/L (range: 3.5-9.5 X 10⁹/L)

B-cell count: 1431.46/μL (range: 80-616/μL)

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