I had a look at NEQAS 2204DM on 28 July when I was presented with a frankly horrible-looking blood film and the description:
"A 67 year old man attends his family doctor following two weeks of fatigue and new abdominal pain. His total white count is found to be 81 x10^9 and a film is prepared for your attention - what do you think?"
Quite frankly I thought "yuk" and were it a genuine
case I would be phoning the consultant haematologist thereby passing on the
problem to someone who would be better placed to deal with it.
However although it is an honest
answer of what I would actually do, that isn't what the nice people at
NEQAS want to hear.
So...
The obvious problem is the white cells. Far too many of them. there are mature granulocytes present, but also myelocytes, myeloblasts and ruptured myeloid cells. There were a few basophils too, and that is never a good sign. Smear cells were seen too.
The platelet count was raised with large platelets and clumps present.
The red cells show anisopoikilocytosis with some spherocytes and some red cell fragments.
Is it an acute leukaemia? I don't think so. For all that there are blast cells, there are more mature cells too. And the platelet count was not reduced. The abdo pain together with the red cell picture makes me consider CML... It was a shame that the software didn't allow me to put my findings in order of priority (like it asked me to)
The results came in today…
“This is a blood film from a patient with chronic myeloid leukaemia (CML). The myeloid expansion in blood with a predominance of relatively normal (although not always completely normal) late myeloid precursors (myelocytes) and neutrophils is typical. Blasts and nucleated red cells are often seen but should be infrequent in typical chronic phase CML. Basophilia in blood is typically present, but the basophils may be degranulated or atypical so it is important to specifically seek them on the blood film.”
I got that right…
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