Hematology Case 49
Presented By Dr Mohammad Moharram - Dr Monier Quot Eissa
Released on 7-2-2021Patient Data
28 year old male
Clinical Data
No history of any chronic illness.
Presented with Pallor , No Jaundice.
Splenomegaly (5 Fingers below costal margin)
Related Laboratory Results
CBC:
- WBC: 402.6 x103 /uL . (Neutrophils: 89%)
- HGB: 10.7g/dL - MCV: 88.8fL -MCH: 30.1 pG - MCHC: 33.9%
- Platelet: 308x103 /uL
LDH: 1012 u/L (R.R.: 98-192)
Normal RFT & LFT.
Provisional Diagnosis
?? Myeloproliferative disorder.
Case Picture(s) / Photo(s)
B.M. Aspirate
B.M. Trephine biopsy
Comment / Findings
Bone Marrow Aspirate:
Differential Cell Count: Promyelocytes: 11% - Myelocytes: 21% - Metamyelocytes: 20% - Band neutrophils: 16% - Segmented Neutrophils: 12% - Eosinophils & their precursors: 6% - Basophils & their precursors: 5% - Lymphocytes: 0.5% - Plasma cells: 0.5% - Blast cells: 5%.
Comment: Markedly hypercellular Bone Marrow. Markedly increased myeloid series with eosinophilia and basophilia.
A Case of myeloproliferative neoplasm mostly chronic myeloid leukemia.
Recommendations: Philadelphia chromosome / BCR-ABL fusion gene work up is recommended.
Bone Marrow Trephine biopsy:
Increased cellularity of marrow tissue with predominantly increase in myeloid lineage. High expression of MPO & CD43 (Myeloid). Low Blasts noticed by negative CD34 & TDT. Also negative for E-Cadherin, CD3 & CD79a (negative other lineages).
Final Diagnosis
The case was confirmed as a case of CML (See additional notes below)
Additional Note
Patient sample was sent to outsourced laboratory and the result got was:
Major BCR-ABL P210 (Quantitative) : BCR-ABL has been detected at the level of 100% (IS).