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51. A 28-year-old male is admitted with marked hypoten-
sion and shock. A CBC shows a hemoglobin concentration
of 14.1 g/dL, hematocrit of 42.6%, MCV of 93 tL, WBC
count of 12,[email protected], and platelet count of 127,[email protected] The
peripheral blood smear demonstrates a differential count of
71 segmented neutrophils, 8 band cells, 14 lymphocytes,
and 7 monocytes per 100 WBCs. The neutrophils show
cytoplasmic toxic granulations and Drhle bodies. Which of
the following conditions is he most likely to have?
O (A) Tuberculosis
O (B) Acute myelogenous leukemia
O (C) Chronic myelogenous leukemia
O (D) Bacterial septicemia
O (E) Infectious mononucleosis




51. (D) Toxic granulations, which are coarse and dark
primary granules, and D/Shle bodies, which are patches of
dilated endoplasmic reticulum, represent reactive changes
of neutrophils. These changes are most indicative of over-
whelming inflammatory conditions such as bacterial sepsis.
Leukemia, granulomatous infections, or viral infections do
not cause toxic changes in neutrophils. Infectious mononu-
cleosis is accompanied by an increase in "atypical" lym-

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