I need your recommendations about a 34 yr old man with lymphocytosis. Patient is an immigrant from India. Lymphocytosis noted on a routine blood check 1 year ago following covid infection. No previous baseline count before 1 year. He had routine lab check by pcp 1 month after his covid infection. Absolute lymphocyte counts fluctuating between 4500 to 5000. His PCP repeated the labs after 6 months and since lymphocytosis persisted he ordered flow cytometry. Flow cytometry at their hospital showed concerns for LGL, so he was referred to hematology. At our facility we repeated another flow cytometry and our pathologist reported flow to be normal without any concerns for LGL. He is clinically asymptomatic without any symptoms and no symptoms related to any chronic infections. We have been monitoring his counts for over a year, ALC is about the same without any other cytopenias. Patient is anxious about his counts. Can you please suggest if I need to do any other work up?
Even were an LGL clone present, no intervention would be indicated given the absence of any significant cytopenias. At this point, I would recommend no further hematologic testing or intervention, and would just monitor (if findings have been stable for a year now, then monitoring CBCS q 6-12 months for now would be adequate). Should ALC ever increase significantly further in future, or should any new cytopenias arise in future, would then repeat peripheral blood flow cytometry as first step.
