Hematology Case 38

Presented By Dr Mohammad Moharram

Released on 15-6-2020

Patient Data

63 year old female

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

  • 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


Case Picture(s) / Photo(s)

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

Picture of myeloproliferative disorder mostly chronic myeloid leukemia.

Cytogenetic study; FISH and PCR are recommended for BCR-ABL1 fusion gene (Philadelphia chromosome)

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.