Hematology Case 20
Hematology Case 20
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Presented By Dr Tamer Soliman
Released on 22-10-2019Patient Data
Patient Data
Female patient 42 years old
Clinical Data
Clinical Data
Patient admitted to hospital with sever chest pain, dyspnea, cough and hemoptysis. By clinical examination pulmonary embolism/infarction was suspected.
Related Laboratory Results
Related Laboratory Results
Lab investigations were ordered (CBC, Coagulation profile and D-dimer) and the result was:
WBCs : 29.0 x 10^3/mm3
RBCs : 2.12 x 10^6/mm3
Hb : 6.2 g/L
PLT : 26 x 10^3/mm3
PT concentration : 60%
aPTT : 66.2 seconds
D-dimer : 1.2 µg/mL (Reference < 0.5 µg/mL)
PB smear examination "see below"
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
Comment / Findings
Comment / Findings
PB smear examination showed the presence of 95% of abnormal myeloid precursors, most of them showed bilobed (or butterfly) nuclei with agranular basophilic cytoplasm. Occasional schistocytes could be noticed in the blood film.
Final Diagnosis
Final Diagnosis
Diagnosis : Acute Promyelocytic Leukemia (APL) - microgranular variant for confirmation by:
- BM biopsy/Aspirate examination
- Cytochemistry: SBB/MPO (to confirm APL) and NSE (to exclude Monocytic Leukemia)
- Genetics: t(15;17)
-Immunophenotyping: CD13, CD33, CD34, HLA-DR, CD64, CD117
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