Hematology Case 62
Hematology Case 62
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Patient Data
Patient Data
31 year old male.
Clinical Data
Clinical Data
Known case of CML (Philadelphia positive) diagnosed 4 year ago.
He is not on any treatment 6 months ago.
Presented with both wrist & elbow pain & swelling.
Related Laboratory Results
Related Laboratory Results
CBC:
- WBC: 87.8x103 /uL
- HGB: 9.1 g/dL - MCV: 81 fL -MCH:24 pG - MCHC: 29%
- Platelet:1442 x103 /uL
Total bilirubin : 8 umol/L (R.R.: 5.1-20.5) - Direct bilirubin: 1.7 umol/L (R.R.: 1.7-8.6)
AST: 31 u/L (R.R.: 15-41) - ALT: 46 u/L (R.R.: 17-63) - ALP: 116 u/L (R.R.:30-91) - ALB: 36 g/L (R.R.: 35-50).
BUN: mmol/L (R.R.: 2.5-6.4) - Creatinine: umol/L (R.R.: 55-113).
Na:136 mmol/L (R.R.: 135-144) - K: 6.2 mmol/L (R.R.: 3.5-5.1)
LDH: 575 u/L (R.R.: 98-192)
Provisional Diagnosis
Provisional Diagnosis
Relapsed CML Vs Blastic phase of CML
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
Images Comment / Findings
Images Comment / Findings
Peripheral Blood Smear:
Leukocytosis with BLAST cells :76% (Medium sized cells with moderate to high nuclear cytoplasmic ratio, agranular basophilic cytoplasm, open chromatin with 1 to 3 visible nucleoli)
Moderate microcytic hypochromic anemia.
Marked thrombocytosis
Immunophenotyping:
Sample : Peripheral Blood.
The gated blast cells using CD45/SSC gating strategy represents 72%.
They are positive for: CD34, HLA-DR (Bright), CD38, CD13, CD33, CD7, CD11b.
They are negative for: cMPO, CD3, cCD3, CD19, cCD79a, CD4, CD64, CD14, CD2, CD5, CD56, CD20.
Picture of BLASTIC PHASE of CML phenotypically ACUTE UNDIFFERENTIATED LEUKEMIA with aberrant expression of CD7, CD11b, Bright CD11b.
Final Diagnosis
Final Diagnosis
Blastic phase of CML phenotypically acute undufferentiated Leukemia.
Additional Note
Additional Note
Patient is referred to higher center for cytogenetic workup & to start chemotherapy.
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