MICROSCOPIC DESCRIPTION:
| WBC | 68.3 10x9/L |
| RBC | 2.58 10x12/L |
| Hgb | 10.0 g/dL |
| Hct | 28.3 % |
| MCV | 109.8 fL |
| MCH | 38.7 fL |
| MCHC | 35.3 g/dL |
| RDW | 14.7 % |
| PLT | 73 10x9/L |
| Retic |
| Cell Type | Percentage |
|---|---|
| Polys | 9 % |
| Bands | 10 % |
| Lymphs | 33 % |
| Atyp. Lymphs | 4 % |
| Monos | 17 % |
| Eos | 2 % |
| Baso | 1 % |
| Blasts | 7 % |
| Promyelos | 2 % |
| Myelos | 9 % |
| Metamyelos | 6 % |
| NRBC/100 WBC |
The peripheral blood smear was reviewed.
RED BLOOD CELL MORPHOLOGY:
Moderate anisocytosis, occasional microcytes, occasional ovalocytes, slight poikilocytosis, occasional polychromasia, occasional spherocytes, rare teardrops and rare bizarrely formed red blood cells.
Blasts. Occasional monocytes appear immature.
PLATELETS are decreased.
BONE MARROW:
The marrow aspirate smear is adequate (two aspirate smears and one touch imprint reviewed). The marrow biopsy is fragmented and contains a large amount of periosteum.
| Blasts | 50.3 % | |
| Promyelos | 6.0 % | |
| Myelos | 8.0 % | |
| Metamyelos | 5.7 % | |
| Bands | 4.0 % | |
| PMN | 1.0 % | |
| Eos Myelo/Metas | 3.3 % | |
| Eos Bands | 0.3 | |
| Eos Segs | 1.3 % | |
| Basos | 2.0 % | |
| Monos | 2.3 % | |
| Pronormos | 1.0 % | |
| Normos | 3.7 % | |
| Lymphos | 10.7 % | |
| Plasma Cells | 0.3 % | |
| Others | ||
| Myeloid:Erythroid Ratio N/A | ||
| Total # of cells counted: 300 | ||
The overall basophil count was 2%, however, scanning of the particles show a relative increase in basophils. The marrow is markedly hypercellular (95% cellular). The myeloid/erythroid ratio is not evaluable. The marrow contains a heavy infiltrate of blasts with a small cytoplasmic rim, occasionally containing azurophilic granules. A few scattered foci of maturing myeloid and erythroid cells are seen. In addition, several lymphoid aggregates are present. The lymphocytes are primarily small with both round and angulated forms present. Only rare erythroid precursors are seen. The myeloid maturation has a left shift. Megakaryocytes are present in markedly decreased numbers.
The bony trabeculae are unremarkable.
ANCILLARY STUDIES:
| Stain | Usual Reactivity | Results |
|---|---|---|
| Sudan Black | gran, mono | Is positive in myeloid elements |
| Peroxidase | gran, mono | Is positive in more than 5% of the blasts. Other myeloid cells are also positive |
| CAE* | CAE-gran, mast | Is positive in myeloid cells |
| NSE* | NSE-mono, mega | A very fine pattern of positivity is seen in a large number of cells, including blasts and was inhibited by fluoride. I do not interpret this as a monocytic component. Very few large cells exhibit stronger positivity (less than 20%) |
* NOTE: NSE and CAE were performed as a Double Esterase (DE) stain.
Flow Cytometry