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) |
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 Cytometry: