Case Study 9 Yr Old Wbc 150

Case 271 -- Chronic Myeloid Leukemia (CML)

Contributed by Rajendra Persad, MD
Published on line in June 2001


PATIENT HISTORY:

The patient is a 58 year old white female who was diagnosed with Chronic Myeloid Leukemia (CML) positive for the Philadelphia chromosome by classical cytogenetics, seven months previously. A repeat bone marrow performed five months after diagnosis, to assess response to interferon and hydroxyurea treatment findings consistent with CML, with persistence of the Ph chromosome and less than 1% blasts. She is now being evaluated prior to bone marrow transplant.

PB Count:

       Hb   11.1 g/dl   (normal 11.7 -15.7)
       Plt   246 x10E+9/L   (normal 150 -450)
       WBC   84.2 x10E+9/L   (normal 4.5 -11.0)
       Blasts   (1%) 0.84   (normal < 0.02)
       Promyelocyte    (1%) 0.84 
       Promyelocyte   (1%) 0.84    
       Myelocytes   (5%) 4.21    
       Metamyelocytes   (9%) 7.58    
       Bands   (23%) 19.37   (normal 0.1 -0.8)
       Polys   (43%) 36.22   (normal 2.0 - 6.8)
       Basophils    (2%) 1.68    (normal < 0.2)

The peripheral smear demonstrated increased numbers of neutrophils and neutrophil precursors (Images 1 and 2), basophilia (Image 3) and occasional blasts with high N:C ratio, and inconspicuous nucleoli (Image 4). The red cells showed mild anisocytosis and poikilocytosis.

A bone marrow aspirate (Images 5, 6, 7 and 8) and biopsy was performed (Images 9 and 10) with the following differential:

       Blasts   19% (normal 0.0 -2.0)
       Basophils   5.3% (normal 0.0 - 0.2)
       M:E ratio    6.1% (normal 1.5 - 3.3)

The biopsy demonstrated marked cellularity (~100%), with many blasts. Erythroid maturation is slightly megaloblastoid. Myeloid maturation showed left shift. Occasional micromegakaryocyte were identified.

Flow Cytometry:

Flow cytometric immunophenotypic studies (images xi, xii and xiii) demonstrated a population of cells with B-cell lineage phenotype (Positive for CD34, CD19, CD10 and TdT). These constituted 19% of the total cells (Images 11, 12, 13, 14).

Flow Cytometry:

Ph chromosome positive (Image 15)

FINAL DIAGNOSIS




Он называл ее… - Речь его стала невнятной и едва слышной. Медсестра была уже совсем близко и что-то кричала Беккеру по-испански, но он ничего не слышал. Его глаза не отрывались от губ Клушара. Он еще раз сжал его руку, но тут наконец подбежала медсестра.

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