An acute leukemia with two faces
A 5-year old girl visited the emergency ward complaining about fatigue and weight loss. The GP found a normocytic anemia (Hb 4,1 mmol/l). For children Hb ref-range is 6.0-9.0 mmol/L.
The peripheral blood film showed a mild leucopenia (2, 7 x 10 9/l); a lymphocytosis and 1% erythroblasts. Due to the anemia, the patient received an erythrocyte-transfusion. Virus serology (EBV, CMV, mycoplasma, Parvovirus B19) turned out to be negative. After transfusion the patient felt better, Hb normalized and the leucopenia had resolved spontaneously, the peripheral blood film showed no abnormalities. Her previous anemia and leucopenia were therefore contributed to a post viral status. She was discharged from further follow-up and her parents were informed to take renewed contact if symptoms recurred.
Flowcytometry analysis showed CD13 and CD33 positivity of the blast population (CD10+19+20–). Subsequent cytogenetic analysis showed in addition to a complex aberrant genotype, the presence of t(12;21)(p13;q22) (TEL-AML1; ETV6-RUNX1).
This cytogenetic abnormality is associated with CD13/33-positivity in acute lymphoblastic leukemia (ALL). The patient was referred to an academic hospital
for further treatment and analysis.
Thanks to Anne de Grauw, Kathleen Welborn, Warry van Gelder and Jürgen Riedl, Albert Schweitzer Hospital, Dordrecht, the Netherlands who shared this interesting patient case.