Patient is a 44 y/o male with recent hx of worsening abdominal pain, fullness, and fatigue. Labs show mild lymphocytosis (wbc 11.3), mild anemia and thrombocytopenia (hgb 12.3, plt 92k). Iron studies showed ferritin 700, iron 30, transferrin sat 9. CT CAP showed severe splenomegaly with spleen size 24cm. I am concerned about HCL/SMZL/MPN/CLL. I needed help with the initial workup. I ordered repeat cbc, cmp, esr/crp, b12/folate, hiv, hepatitis panel, hemolysis labs, SPEP/IFE, peripheral smear, FISH for BCR-ABL, JAK2V617F w/reflex exon 12, CALR, MPL, as well as peripheral blood flow cytometry. I will perform a bone marrow biopsy. Anything else? What labs would you order on the marrow? Any special NGS orders?

Non-Hodgkin Lymphoma Specialist

You have done a terrific job with his work up so far. Do not think you need to order additional labs on BMBX. Only addition would be BRAF V600E for hairy cell leukemia. If you find a CD5-,CD10- monoclonal B-cell population then diagnosis is most likely splenic marginal zone lymphoma.