Hematology Case 38
Hematology Case 38
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Presented By Dr Mohammad Moharram
Released on 15-6-2020Patient Data
Patient Data
63 year old female
Clinical Data
Clinical Data
Patient was referred form another hospital due to unexplained severe leukocytosis ??
Patient complains of loss of appetite and weight loss.
History of diabetes mellitus
Ultrasound for abdomen shows: hepatomegaly, splenomegaly and multiple gall bladder stones. No focal lesion in the liver or the spleen. No ascites.
Related Laboratory Results
Related Laboratory Results
- CBC:
WBC: 244.3 X 103 /uL
RBC: 3.66 x106 /uL (4.5 -5.5)
HGB: 9.9 g/dL
MCV: 81 fL
MCH: 27 pG
MCHC: 33.4 %
Platelet: 488 X 103 /uL
- LDH: 762 u/L (R.R.: 98-192)
- Uric Acid : 248 umol/L (R.R.: 155-476)
- Normal RFT & LFT
Provisional Diagnosis
Provisional Diagnosis
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
Comment / Findings
Comment / Findings
Marked Leukocytosis
Differential cell count: - Blast cells: 8 %. - Promyelocytes: 3% - Myelocytes: 11% - Metamyelocytes: 15% - Band Neutrophils: 10% - Segmented Neutrophils: 45.5% - Eosinophils: 2% - Basophils: 4%
Absolute neutrophila with shift to left to level of blast cells.
Abolute bsophilia and absolute Eosinophilia.
Normoblasts are seen in peripheral blood: 5 / 100 WBCs.
Moderate normocytic normochromic anemia with anisocytosis.
Mild thrombocytosis.
Final Diagnosis
Final Diagnosis
Picture of myeloproliferative disorder mostly chronic myeloid leukemia.
Cytogenetic study; FISH and PCR are recommended for BCR-ABL1 fusion gene (Philadelphia chromosome)
Additional Note
Additional Note
Patient received hydroxyurea and allopurinol till acceptance of referral. WBC after 9 days of treatment became 8.2X 103 /uL then the patient referred to a higher center. BCR-ABL fusion gene was confirmed by the higher center.
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