This patient presentation is in the form of an abnormal lab value. Labs may have been obtained as a routine panel or based upon a patient’s clinical symptoms. This clinical mind map addresses only a limited number of white cell abnormalities, including leukocytosis and lymphocytosis, and does not address decreased white cell counts, disorders or any non-myeloid/lymphoid cell lines or mixed pictures. After reviewing the lab results and determining whether or not blast cells are present, a clinician can proceed to sort through the probable diagnoses. Probable diagnoses are further chunked on the basis of distinct mechanisms of disease, such as infection, and stress. A mnemonic to memorize disorders with leukocytosis, which do not include blast cells, is SINC. Leukocytic disorders which do include blast cells can be placed into acute and chronic categories. This chunking of differentials may help with memorization.
Urgent/emergent situations include severe myeloid/lymphoid cell line abnormalities which can give rise to severely compromised immune system and represent in the form of a clinical picture of distress, such as severe infection. These scenarios can result in abnormal vital signs and/or appearance of distress.
Weighing and removing anchor bias involves reviewing the patients’ risk factors, demographics, clinical presentation, and gathering physical exam and lab data. A patient’s age is helpful in narrowing differentials as certain diagnoses are more or less common in certain age groups. This distinction is made on this clinical mind map. Generally, any combination of features such as extremely elevated white blood cell count, cluster symptoms such as low grade fever, weight loss, night sweats and absence of focal symptoms, should prompt a clinician to investigate for an underlying malignancy. The absence of the above-mentioned features or the presence of a focus of infection may suggest an infectious/non-malignant process. However, a clinician must pay attention to the possibility of an occurrence of a super-imposed infection in an immunocompromised host, such as a patient with a malignancy. In this case, the patient may present with focal symptoms and clinical features of an acute infection, which may shift the clinician’s focus to treating the acute infection and ignoring an underlying malignant process, thereby leading to anchor bias. Careful evaluation and consideration of all differentials throughout the evaluation process may help avoid this situation.