Patient
presented at GP with abdo pain and lack of appetite.
MOUSE,MICKEY A+ 22/09/2011 u/k
02/02/1951 Male
696969 ITU
abdopain not eating
drinking..
U LONC
Specimen
No :
AK672862H Selected
Auth Level : E
HB
13.5 S000 MONO 2.6
S000
WBC
7.4 S000 EOS 0.4
S000
PLT
44 S000 BASO 0.1
S000
RBC
4.52 S000
HCT
0.415 S000
MCV
91.8 S000
MCH
29.9 S000
MCHC
32.5 S000
NEUH
0.3 S000
LYMPH
4.1 S000
|
The
biochemistry showed:
Sodium
137
mmol/L (133 to 146) Auth
Potassium 4.1
mmol/L (3.5 to 5.3) Auth
Creatinine 274
umol/L ( 64 to 104) Auth
GFR
(estimated) 20 units=* Auth
Total
Protein 70 g/L
( 60 to 80 ) Auth
Albumin 33
g/L ( 35 to 50 ) Auth
Total
Bilirubin 27 umol/L
( 0 to 29 ) Auth
Alk Phos 324
U/L ( 30 to 130) Auth
ALT 25
U/L ( 0 to 70 ) Auth
Calcium 2.3
mmol/L (2.2 to 2.6) Auth
Alb-cor
calcium 2.4 mmol/L
(2.2 to 2.6) Auth
Urate 649 umol/L
(200 to 430) Auth
CRP 122
mg/L ( 0 to 10 ) Auth
The
blood film showed blast cells, and the case was referred to consultant
haematologist
CIRCULATING
LYMPHOBLASTS . THROMBOCYTOPENIA . NO VISIBLE PLATELET CLUMPS.
NEUTROPENIA.
COULD BE NEWLY PRESENTING ALL. MEDICAL TEAM
INFORMED
URGENTLY
Subsequent
investigations showed:
Coag:
PT 16.4 s (12 to 16) Auth
APTT 39.8 s (22.0 to 35) Auth
Fibrinogen 5.44 g/L (1.90 to 4.30) Auth
Thrombin
Time 16.9 s (13 to 20) Auth
Reptilase
time 17.3 s (14 to 19) Auth
Serum
Total protein 70 g/L (60 to 80) Auth
Serum
Albumin 33 g/L (35 to 50) Auth
Globulin 37 g/L
(20 to 35) Auth
Electrophoresis showed the following: Auth
Comments :
Increased alpha 1 & 2 globulins
Slight polyclonal increase in
gammaglobulins.
This electrophoretic pattern is consistent
with an acute phase
response.
Bone marrow was aspirated and scrutinised:
Bone
Marrow Investigation:
Report
Sequence No.1 22/09/11 09:50
Status : S000
BONE
MARROW ASPIRATE AND TREPHINE FROM RPIC EASILY OBTAINED
APARTICULATE
HYPERCELLULAR TRAILS
MEGAKARYOCYTES
PRESENT WITH SOME HYPOLOBATED FORMS PRESENT.
DIFFERENTIAL
BLASTS 80% PRO 1% META 1% ,MYELO 1%
NEUTROPHILS
3% LYMPHOCYTES 4% EOSONOPHILS 2%
ERYTHROID
8%
ERYTHROPOIEISIS
AND GRANULOPOIEISIS MARKEDLY REDUCED AN EXCESS OF LYMPHOBLASTS PRESENT
ACCOUNTING FOR 80% OF CELLS.
CONSISTENT
WITH ACUTE LYMPHOBLASTIC LEUKAEMIA
|
Reference
Laboratory reported on Immunophenotyping and bone marrow:
Results from a gate
representing approx. 97% of Total Nucleated Cells (TNC’s):
Immunophenotyping
demonstrates a CD34+ cell population representing approx 48% TNC’s with a
profile typical of myeloid progenitors (CD13+, CD33-, 1/2CDCD117+, 1/2HLA+,
MPO+ and LYSO-).
|
BONE
MARROW ASPIRATE AND TREPHINE EASILY OBTAINED FROM
RPIC
OLIGOPARTICULATE
HYPERCELLULAR PARTICLES AND TRAILS VERY FEW MEGAKARYOCYTES SEEN AND
HYPOLOBATED
DIFFERENTIAL:
BLASTS 80% PROMYELOCYTES 9% MYELOCYTES 5% ERYTHROID 6%
AN
EXCESS OF MYELOBLASTS OF TYPE 1 MORPHOLOGY SEEN WITH MARKEDLY REDUCE ERYTHROPOIEISIS
AND GRANULOPOIESIS. CONSISTENT WITH A DIAGNOSIS OF ACUTE MYELOID LEUKAEMIA
VERIFIED
BY HAEM MDM
|
The
final word on the diagnosis came from the reference laboratory:
Consultant
Comments: Type 1 Blasts account for over 90% of TNC’s. Type 2 blasts
occasionally seen. No Auer Rods. Blasts are medium-large sized. Consistent
with AML (M1) by morphology and Immunophenotyping.
|
So the final diagnosis was AML (M1). The
moral of this story is that in acute leukaemias, the morphology can be
misleading. Consultant medical staff can be unsure on the differentiation
between myeloblast and lymphoblast. The final diagnosis must be made by flow
cytometry which looks for specific cell markers.
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