QSP Newsletter

QSP Newsletter 42 - Acute Leukemia

December 2023

Monthly Digital Case Study
December Slides
Slide 1 Review Continued
Quiz
(PDF for print)

Monthly Digital Case Study (QSP Slide 1, December 2023)

Presentation

Male 80 years old.
Deterioration of health state.
Hyperleukocytosis+
Thrombocytopenia
Leucocyte differential with alarm

Additional information
Highly degranulated / agranulated Neutrophil. Thrombocytopenia

Majority population of mostly granular blasts (estimated at 80% of leukocytes), in favor of Acute Myeloid Leukemia.

Expert’s comment: AML probably AML 1/2.

FBC Results

WBC 89.1 (10^3/mm3)Neutrophils 11.9 (%)
RBC 3.48 (10^6/mm3)Lymphocytes 1.5 (%)
HGB 11.9 (g/dL)Monocytes 3.0 (%)
HCT 35.3* (%)Eosinophils -
MCV 102 (fL)Basophils -  (%)
MCH 34.2 (pg)Blasts 83.6 (%)
MCHC 33.7 (g/dL) 
PLT 46* (10^3/mm3) 
Blast Cell

Blast Cell

Blast Cells

Blast Cells

Agranular Neutrophil

Agranular Neutrophil

December Slides

See monthly case study above.

Geriatrics unit. 

Anemia, Anisocytosis(++).

Neutrophilia (Deganulated/agranulated neutrophils).

Myelemia (Degranuled immature granular cells).

Thrombocytopenia.

MDS/MPS?

Expert's comments: Atypical CML?

Monomorphic hyperlymphocytosis associated with numerous smudge cells compatible with a lymphoproliferative syndrome (CLL type?).

The diagnostic approach must be completed by a request of blood lymphocyte immunophenotyping by flow cytometry, with establishment of the Matutes scoring and cytogenetic analysis.

Note the presence of macro-platelets (see giant platelets) as well as numerous platelet aggregates: DO NOT REPORT platelets result.

Add a comment e.g.: "underestimation of platelets count: PLT cluster".

Expert's comment: Count "smudge" cells in lymphocyte count (if lymphocyte count to be reported by manual method).

 

Composite type major sickle cell syndrome (beta-thalassemia/hemoglobin S).

Recommendation: Platelets result to be checked on a citrate sample

Expert's comments: "Difficult patient to sample?

Presence of rare macroplatelets and rare platelet clusters.

Slide 1 Review Continued

The term AML M1 or M2 relates to the French-American-British (FAB) groups classification of Acute Leukemia's and Myelodysplastic Syndromes. The FAB classification was developed in the 1970’s firstly as an aid to differentiate Acute Lymphoid from Acute Myeloid Leukemia, classification is based solely on the cytochemical morphology of cells to elucidate their lineage and maturation. In the 1980’s further development of the FAB classification sub divided the Acute Myeloid Leukemia's into 8 categories based upon the morphological features of the cells:-

M0 – AML with minimal evidence of differentiation

M1 – Poorly differentiated no Myeloid maturation

M2 – Myeloblastic with some Myeloid maturation

M3 and M3v – Promyelocytic Leukemia

M4 – Acute Myelomonocytic leukemia

M5a and M5b  – Monoblastic Leukemia

M6 – Erythroblastic Leukemia

M7 – Megakaryoblastic Leukemia

With the development of techniques such as cytogenetics and immunophenotyping the World Health Organization (WHO) proposed a new classification which was based on the genetic, immunophenotypic, biological and clinical features of patients to better define specific disease entities.

 

The WHO classification of AML (briefly)

AML with myelodysplastic syndrome, therapy related

AML with recurrent genetic abnormalitiese.g. AML with t(8;21)(q22;q22), AML1(CBFA)-ETO fusion gene, Acute Promyelocytic Leukemia (AML with t(15;17)(q22;q11-12) and PML-RARA fusion gene or variants with RARA .

AML with multilineage myelodysplasia

AML Not Otherwise Categorized.in such cases the FAB classification is used.

Christmas Quiz

Let’s see what we remember for the previous cell quiz questions and morphology articles.

Quiz 1

What word describes changes in Red Blood Cell shape?

Quiz 2

What cell can either be T or B?

Quiz 3

QSP_42_-_quiz_3

Can you identify this white cell?

Quiz 4

What Red cell inclusion may be “happy”?

Quiz 5

QSP_42_-_quiz_5

What feature can be seen in this red cell?

Quiz 6

QSP_42_-_quiz_6

Can you identify this cell?

Quiz 7

QSP_42_-_quiz_7

What feature is seen in this film?

Quiz 8

Which of these feature may be seen in Neutrophils during infection?

a) Neutrophil left shift
b) Excess Granulation (Neutro-Toxic Granulation)
c) Pappenheimer bodies

Quiz 9

QSP_42_-_quiz_9

What term is used for the red cells in the picture?

Quiz 10

What cells name is the same as Mistletoe berries?

a) Platelet
b) Red Cell
c) White cell

Last Month’s Quiz Answer

Quiz cell #41

What morphological  features can be seen in the cell from a Romanowsky stained blood film?

A) Heinz Bodies
B) HbH
C) Basophilic Stippling

The Answer:

C) Basophilic Stippling. Basophilic stippling is a frequent manifestation of hematologic disease in the peripheral blood. Fine basophilic stippling is associated with increased red cell production and is commonly seen when there is increased polychromatophilia. Coarse basophilic stippling is seen in megaloblastic anemia and other forms of severe anemia's, lead poisoning, and thalassemia.

Quality Slide Program (QSP) 2.0

Available as a single use license and a site license which allows up to 50 concurrent users.

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