Hematology Case 40
Presented By Dr Mohammad Moharram
Released on 25-6-2020Patient Data
88 year old male.
Clinical Data
Patient has long history of diabetes mellitus and hypertension.
In 2016 patient had rectal mass that was confirmed as invasive adenocarcinoma. Secondaries was found last year confirmed to metastatic of the primary lesion. The patient received radiotherapy in a higher center.
Patient also had basal cell carcinoma of perineum 4 years ago that was treated with X-ray Therapy.
This month; patient visited our hospital for follow up where we found sudden increase of WBCs.
Clinical examination showed hepatosplenomegaly and minimal lower limb oedema.
Related Laboratory Results
- BUN: 8.3 mmol/L (R.R.: 2.5-6.4)
- Creatinine: 103 umol/L (R.R.: 55-113)
- Albumin: 26 g/L (R.R.: 35-50)
- AST: 48 u/L (R.R.: 15-41)
- ALT: 24 u/L (R.R.: 17-63)
- ALP: 171 u/L (R.R.: 32-91)
- LDH: 518 u/L (R.R.: 98-192)
- CBC " 1st visit": WBC: 118.5 X 103 /uL - HGB: 12.1 g/dL - MCV: 96 fL - MCH: 29.5 pG - MCHC: 31.2% - Platelet: 262 X 103 /uL- Peripheral smear and differential count → see images and comment below.
- CBC " 2st visit- 9 days from the 1st": - WBC: 225.6 X 103 /uL - HGB: 10.1 g/dL - MCV: 94 fL - MCH: 29.8 pG - MCHC: 31.7% - Platelet: 208 X 103 /uL- Peripheral smear and differential count → see images and comment below.
Case Picture(s) / Photo(s)
Comment / Findings
- CBC " 1st visit": Differential Cell Count: - Blast: 26% - Promyelocytes:2.5% - Myelocytes: 3.5% - Metamyelocytes: 4% - Band Neutrophils: 11% - Segmented Neutrophils: 49% - Lymphocytes: 4.5% - Monocytes: 2% - Eosinophils: 1.5% - Basophils: 1%
- CBC " 2st visit: Differential Cell Count: - Blast cells: 43% - Promyelocytes: 1% - Myelocytes: 2% - Metamyelocytes: 3% - Band Neutrophils: 8% - Segmented Neutrophils: 37% - Eosinophils: 2% - Monocytes: 2% - Basophils: 1% - Lymphocytes: 1%.
Final Diagnosis
A case of Acute myeloid leukemia mostly therapy related acute myeloid leukemia.
Bone marrow aspirate and trephine biopsy, immunophenotyping and cytogenetic study are recommended
Additional Note
Patient and his family refused Bone marrow aspirate and trephine biopsy. They also refused referral to higher center for the recently developed Acute Leukemia.
N.B. I couldn't get the radiotherapy protocol to consider it as definit case of t-AML.
