Hematology Case 31
Presented By Dr Mohammad Moharram
Released on 06-04-2020Patient Data
66 year old female
Clinical Data
Fever with chills. Weight loss. Loss of appetite.
No palpable cervical LN. No Organomegally.
Pancytopnea.
Picture of DIC due to sepsis.
Chest X ray: Increased bronchovascular margins, Mild bilateral pleural effusion.
Related Laboratory Results
W.B.C.: 2.87 LOW ABNORMAL 10^3/uL [4-10]
HAEMOGLOBIN: 10.10 LOW ABNORMAL g/dL [12-15]
PLATELET COUNT: 12 PANIC X10^3/UL [150-450]
D-DIMMER : 14229 HIGH ABNORMAL ng/mL [0-500]
PT: 23.70 HIGH ABNORMAL SEC [11-15]
INR: 2.08 HIGH ABNORMAL Ratio [0.9-1.2]
AST(SGOT) : 68.80 HIGH ABNORMAL U/L [0-32]
TOTAL BILIRUBIN : 21.80 HIGH ABNORMAL umol/L [0-21]
LDH: 984 HIGH ABNORMAL U/L [98-192]
VITAMIN B12: 1592 HIGH ABNORMAL pg/mL [240-900]
FOLATE SERUM: 14.36 NORMAL nmol/L [7-30]
Bone Marrow Aspirate was done (see below)
Case Picture(s) / Photo(s)
Comment / Findings
Hypercellular Bone Marrow with dysplastic features.
Bone marrow blast cells : 7.5%
Increased both erytheroid and myeloid lineages and decreased Megakaryocytes.
Erytheroid lineage shows Binuclearity , nuclear lobulation, nuclear fragmentation, intercytoplasmic bridging, karyorrhexis and megaloblastosis. Relative increase of basophilic and polychromatic normoblasts , many of them show cytoplasmic vacculations.
Myeloid lineage shows increased cell size, increased cytoplasmic granulations, relative decreased of mature neutrophils (hyposegmentation) , cytoplasmic vacculations, karyorrhexis.
Megakaryocytes show relative decrease in number. Some of them are micromegakaryocytes, mononuclear and binuclear
Final Diagnosis
Picture suggestive myelodysplastic syndrome with excess blast for bone marrow iron stain and cytogentic study.
Additional Note
It was decided to refer the patient to higher center for cytogenetic study but unfortunately, patient died 2 days later due to DIC.