Early diagnosis of leukemia in a child with Down syndrome

A 4-year-old child with Down syndrome came to the Albert Schweitzer Hospital in Dordrecht for a routine check-up with his pediatrician. In our lab, blood cell counts showed a normal hemoglobin level (7.4 mmol/L; 11.9 g/dL), mild thrombo-cytopenia (platelet count 98 x 109/L) and a normal leukocyte count. Morphological analysis of the peripheral blood smear ...


The Strange Case of Dr Jekyll and Mr Hyde

An 18-year-old male was examined in the emergency room of one of our hospital locations. He was referred by his GP because of general discomfort and abdominal pain. The patient had no fever, no night sweats and no weight loss. Physical examination revealed lymphadenopathy in neck, axilla and inguinal area; otherwise no significant findings. Laboratory ...


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 ...


Challenging the high volume of smears

Introduction The advances in automated blood cell counter successfully provide the precise data of WBC, RBC, and platelet counts with leukocyte differentials. However, the differential information by blood cell counters is limited for cell morphologic features especially for abnormal and immature cells, and the morphological smear reviews triggered by specific flagging of automated analyzer are ...


Metastatic carcinoma of the pituitary gland

A 71 year old woman presented with a 3 week history of weight loss, nausea, vomiting and severe depression. Physical examination disclosed no abnormalities. Her past medical and family history was unremarkable. Standard laboratory tests including electrolytes were normal. In order to detect the reason for her symptoms extensive diagnostic procedures (CT-Scans, endoscopy of the ...


Natural killer cell proliferations

Natural Killer (NK) cells constitute up to 15% of all white cells in the peripheral blood and a small proportion of cells in the normal bone marrow. However they cannot be readily distinguished morphologically from other lymphocytes and identification relies on flow cytometric analysis.  Typically the NK cell has the appearance of a large granular ...


Comparison of educational methods for medical students

Introduction Digital imaging is a useful tool for laboratory hematology education. Although digital presentations (eg. digital atlases) are increasingly common for medical education, interactive multimedia programs have not been well established. We therefore wished to develop a digital educational program of laboratory hematology for medical students, which is also utilized for proficiency testing. In our trials, ...


B-acute lymphoblastic leukemia (B-ALL)

Cellavision-assisted identification of subtle blasts in a blood smear from a patient with B-acute lymphoblastic leukemia (B-ALL) B-acute lymphoblastic leukemia (B-ALL) can have morphology very similar to mature lymphocytes, but  modern hematology analyzers reliably will alert the operator with a “blast” flag (1, 2).  However, since these same analyzers have a significant false positive “blast” ...


Detecting leptomeningeal spread of AML

Conditioning procedures prior allogeneic stem cell transplantation aim on the eradication of all malignant cells as the prerequisite for cure. However many drugs used for conditioning do not reach all anatomical compartments, since these are separated by a special structure and are therefore called “sanctuary sites”. This is particularly true for the central nervous system ...


Acute promyelocytic leukemia

A 36-year old Caucasian male without a relevant medical history was admitted to the emergency ward of a local hospital (Albert Schweitzer Hospital, Dordrecht, The Netherlands), because of acute chest pain. An anterolateral myocardial infarct was diagnosed (laboratory results showed: Troponine-T: 0,35 µg/L (elevated) and CK: 453 U/L (elevated)) and  the patient was referred to ...


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