Hematology Case 17

Presented By Dr Mohammad Moharram

Released on 2-10-2019

Patient Data

52 year old male

Clinical Data

Previously diagnosed as CML on treatment.

Referred from another hospital with abdominal distention associated with dizziness , constipation and sometimes dysuria.

By examination patient looks ill , his abdomen is rigid and tense. He has huge splenomegally.

Related Laboratory Results

  • WBC: 577x103/uL (Diiferential count see below)
  • HGB: 8 g/dL
  • MCV: 101 FL
  • MCH: 40.5 PG
  • MCHC: 41 %
  • Platelet: 140 X 103/uL
  • INR : 1.6
  • LDH: 1723 u/L (R.R.: 98-192) "Increased 3 days after admission to 4113 u/L"
  • ALP: 257 u/L (R.R.: 32-91)
  • AST : 48 u/L (R.R.: 15-41) "Increased 3 days after admission to 166 u/L"
  • Other liver functions , renal functions , amylase , lipase are normal.

Provisional Diagnosis

Chronic phase of CML has been progressed to Acceleration phase or Blastic crisis

Case Picture(s) / Photo(s)

Comment / Findings

Marked Leukocytosis:

  • Blast Cells: 28%
  • Eosinophils : 8.5% with shift to left to level of myelo-eosinophils
  • Basophils : 5 %
  • Monocytes: 1.5
  • Lymophocytes: 1%
  • Neutrophils : 56 % with shift to left to level of promyelocytes

Normoblasts are seen : 2 / 100 WBC

Mild thrombocytopnea

Moderate normocytic normochromic anemia (False high indices are due to Marked Leukocytosis interfering with measurement method)

Final Diagnosis

Picture of CML in Blastic Crisis