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Chase the Case #29

- Chronic Myelomonocytic Leukemia -

February 2024 
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Patient Demography: Male, 85 years old

Diagnosis: Anemia with Bi-Cytopenia

Symptoms: Generalized weakness, loss of appetite, low grade fever, weight loss

Microscopic Review: Blast: 4%, Neutrophil: 13%, Eosinophils 1%, Lymphocytes: 16%, Monocytes: 43%, Abnormal monocytes: 14%, Myelocytes: 9%. Dysplasia seen in granulocytic series cells (Degranulation and loss of nuclear segmentation in neutrophil series of cells seen)

How Yumizen Can Assist: On the DIFF scattergram, we observe a population corresponding to the immature cell presence as an overlap in Neutrophils and Monocytic threshold. This is due to the dysplasia noted on the WBC differential. The population is situated between the granulocytic-IMG (on slide microscopy seen as Myelocytes, dysplastic neutrophils) and monocytic-IMM (vacuolated Monocytes) immature cell lines. On the BASO histogram, we observe the immature granulocytic population.

HORIBA Medical Chase the Case #29 - Chronic Myelomonocytic Leukemia

This clinical case has been provided by Dr. Trupti Shetty, Dr. Leena Salunke, Dr. Anupa Dixit, Mr. Manohar, Dept. of Hematology Suburban Diagnostics Reference Laboratory, Mumbai, India.

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HORIBA Medical Chase the Case #29 - Chronic Myelomonocytic Leukemia
Total immaturity of WBCs is of clinical importance to identify the morphologies and classify infections, inflammations, or hematology malignancies. HORIBA’s HELO 2.0 and Yumizen H2500 hematology analyzer not only identify the total immaturity of WBCs by the flag but also provide the total immaturity count as LIC parameter, along with its sub-lineage counts as IMG, IMM, and IML. Here, we present a case of Chronic Myelomonocytic Leukemia, presenting the utility of the WBC Total Immaturity parameters that support the diagnostic approach for further confirmations and clinical management, improving laboratory efficiency.
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