Hematology Case 64
Presented By Dr Mohammad Moharram
Released on 09-05-2023Patient Data
11 year old boy
Clinical Data
Abdominal pain - Fevere - Weight loss
Related Laboratory Results
CBC:
- WBC: 59.03x103 /uL (Diff.Count by cell counter: Neutrophils: 7.64x103 /uL - Lymphocytes:45.5 x103 /uL - Monocytes: 4.6x103 /uL - Eosinophils: 0.2x103 /uL - Basophils: 1x103 /uL).
- HGB: 11.7 g/dL - MCV: 81fL -MCH:26.7 pG - MCHC:33.1% - Reticulocytic count%: 2.13 % (R.R.: 0.5-2) - Absolute Reticulocytic count: 93.5 x109 /uL (R.R.: 50-100)
- Platelet:31 x103 /uL
Peripheral blood smear : see below
Case Picture(s) / Photo(s)
Images Comment / Findings
Peripheral Blood Smear:
Leukocytosis with blast cells: 74% - Blast cells are small to medium sized with high nuclear/ cytoplasmic ratio, basophilic cytoplasm, open chromatin of the nucleus with 1 to 2 visible nucleoli & some of the blast cells have clefted nucleus
Mild normocytic anemia with mild anisocytosis
Severe thrombocytopenia
Immunophenotyping :
Sample: Peripheral Blood
Gating: SSC/CD45
Positive markers: CD45(dim), CD34(hetrogenous), cCD3 , sCD3(dim), CD2, CD5, CD7, and CD38.
Negative markers: cMPO, CD19, cCD79a, CD4, CD8, HLA-DR, CD13, CD33, CD11b, CD56, CD14, CD16, CD20, and CD22.
Comment: The gated blast cells using SSC/CD45 dim gating strategy is 68%. They express immunophenotype of T- Acute lymphoblastic leukemia/Lymphoma (T-ALL/LBL)
Final Diagnosis
T- Acute lymphoblastic leukemia/Lymphoma (T-ALL/LBL)