March 2017 - Presented by Dr. Amir Ghorbani

Clinical History

A 13-year-old female with past medical history of Sickle cell disease (Hb SS disease) had multiple transfusions, iron overload, abnormal transcranial doppler (TCD), status post hematopoietic stem cell transplant (HSCT) complicated with GVHD in skin and lungs during transplant course, HHV6 reactivation, Oral/labial HSV infection.

Approximately 7 months after the HSCT, she found to have 16% immature mononuclear cells in CBC-diff report. Peripheral blood flow cytometry showed CD5+/CD20+ population, which comprised of 20% of total cells (66% of lymphocytes) with the following phenotype:

  • Positive for:
    CD19, CD20, CD5, CD38, K/L ratio of 2.3, subset HLA-DR, FMC7, small subset CD23
  • Negative for:
    CD3, CD4, CD8, CD2, CD7, CD10, CD34, CD117, CD56, CD138, CD15, CD3

Click image to enlarge

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What is the best course of action?

Choose one answer and submit.


The correct answer is

D. It is a reactive process and there is no need for further action.

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