Microscopic Description -- Sore Throat and Leukocytosis


Peripheral Blood
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

Peripheral Blood Differential
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 %

The peripheral blood smear was reviewed.


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.


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.

Bone Marrow Differential
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 %
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.


Cytochemical Stains
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


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