Virginia – Internal Medicine – Elevated White Blood Cell Count With Immature Granulocytic Cell Population

On 10/28/2013, a patient’s laboratory results, as reviewed by an internist, indicated a markedly elevated white blood cell count and immature granulocytic cell population.  The pathologist’s blood smear review and consultation report noted immature granulocytic cell findings along with nucleated red blood cells and abnormal red blood cell morphology on smear, and suggested “full hematologic evaluation if clinically indicated.”  The internist did not order a full hematologic evaluation for the patient as recommended by the pathologist.

On 12/3/2013, the laboratory blood test results, which the internist reviewed and signed, again indicated a markedly elevated WBC and granulocytic cell population.  The internist again did not order a full hematologic evaluation for the patient.

On 5/28/2014, the patient presented to another physician who ordered laboratory results.  When the blood test results indicated a markedly increased number of white blood cells, the physician referred the patient to a hematologist-oncologist, who diagnosed the patient with a myeloproliferative neoplasm.

The internist stated that she did not order a hematologic evaluation after receiving the 10/28/2013 because she did not believe it was clinically indicated at that time.  The internist had ordered it for 12/13/2013 and reviewed the results and had planned to consider referral to a specialist based on the next lab work results.

The internist stated that she expressed concern to the patient about his white blood cell count during his 1/7/2014 office visit.  At that visit, which was a “sick visit,” the patient informed her that he was leaving the country in eight days for a three-month visit to Vietnam.  The internist stated that she urged the patient to have his blood recheck while he was away and when he was no longer ill.

The Board issued a reprimand and ordered the internist to take a continuing medical education course in the subject of interpreting complete blood count laboratory data.

State: Virginia


Date: January 2016


Specialty: Internal Medicine, Family Medicine


Symptom: N/A


Diagnosis: Hematological Disease


Medical Error: Failure to follow up


Significant Outcome: N/A


Case Rating: 3


Link to Original Case File: Download PDF



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