Osler Round 5 - Osler Grand Round - June 2026

The clinical case

D.T, a 70-year-old male presented with progressive abdominal swelling and a sensation of left-sided fullness for the past month. He reports a 1-month history of generalized body weakness, significant unintentional weight loss, and drenching night sweats. He explicitly denies lower limb swelling, fevers, bone pain, or abnormal bleeding. He is chronically ill-looking, noticeably wasted (cachectic), and anxious. Mild conjunctival pallor is present. There is no jaundice, peripheral lymphadenopathy, or pedal edema. The abdomen is moderately distended. There is massive, firm, non-tender splenomegaly extending 17 cm below the left costal margin, crossing the midline, with a distinct splenic notch palpable. The liver is not enlarged, and there is no shifting dullness. Other Systems: Completely unremarkable. Laboratory Investigation (Hematology Analysis Report): WBC: 349.2 x 10^9/L , RBC: 2.67 x 10^12/L, HB: 10.3 g/dL, HCT: 24.7%, Platelets (PLT): 96 x 10^9/L (Borderline thrombocytopenia), Granulocytes 47.3% (GRAN# 165.3 x 10^9/L), Lymphocytes 30.2%, Mid-cells/Mixed 22.5% (MID# 78.5 x 10^9/L).