Cell Case #20

This Cell Case presents a 15 year old boy presented at the GP’s office. He had stomach complaints and a swollen abdomen.

Result from the cellcounter:

Leukocyte was highly elevated (330 x109/L); anemia and slight trombocytopenia. Differential count showed 20% blasts.

The cells looked like this:


Do you know the most likely diagnosis?  Please post your suggestion!

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/ The CellaVision Blog Team

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This blog is created by CellaVision for laboratory professionals with a particular interest in hematology and digital cell morphology. Our aim is to inform, educate and inspire in equal measures – by highlighting interesting articles, sharing interesting patient cases and cell images, and presenting inspiring success stories from our community of CellaVision-users from around the world.

22 thoughts on “Cell Case #20”

  1. High WCC with left-shifted granulocytes, prominent basophils and blasts. Suggest CML in accelerated or blast phase.

  2. Is this the firt time of diagnosis ?
    To diagnose blast crisis, I do complete blood and differential counts and a bone marrow analysis with cytogenetics. Cytogenetic evolution is the most consistent predictor of blast transformation. Flow cytometry or cytochemistry is needed to determine the type of blast crisis phase (myeloid or lymphoid). Molecular genetics with mutation analysis are needed to choose the appropriate tyrosine kinase inhibitor (TKI). Consensus recommendations when to perform mutation analyses have been published on behalf of the European LeukemiaNet.
    A new definition would regroup approximately 10% of patients. Patients with 20% to 29% blasts have significantly better prognoses than patients with more than 30% blasts.

  3. Chronic Myelogenous Leukemia (CML) is a chronic myeloproliferative disease whose clinical stage could be in the case shown: fever, bone pain, night sweats progressive splenomegaly resistant to treatment Increased score FAL – Peripheral Blood: Anemia, thrombocytopenia (20% blasts 10% to 19% – Bone marrow. Hypercellular :: peripheral blood neutrophilic leukocytosis with myeloid precursors (myelocytes and metamyelocytes), eosinophilia, basophilia leukocyte alkaline phosphatase (FAL) absent or diminished, hyperuricemia, Blasts 10% to 19%..
    The cytogenetic study is a methodology that has high specificity and low sensitivity, thus its implementation at diagnosis and until it reaches complete cytogenetic response (CCR) is recommended. It should be in bone marrow (1-2ml the first aspirate) extracted heparin. In 95% of cases the t (; 22 9) is detected (q34; q11), while the remaining 5% may have variants of classical or chromosome translocation or cryptic Ph’ masked. If the cytogenetic study performed for diagnostic purposes and Ph’ observed chromosome 20 metaphases reading is enough. If the karyotype is normal or there is insufficient number of metaphases complement the study with FISH and PCR. If the cytogenetic monitoring study should be analyzed metaphases 20-25 to define the type of cytogenetic response achieved. In CML it has been observed that the positive clone Ph’ cytogenetic alterations can acquire new addition to the classic Ph chromosome which is called.
    Molecular study BCR-ABL quantitative (qRT-PCR) The qRT-PCR is a highly sensitive method for quantifying the BCR-ABL transcripts relative to a control gene (ABL). Using specific primers and probes and requires a team of real-time PCR. It is made from samples of SP (10ml) or MO (1 ml) extracted with EDTA. The result of the qRT-PCR to estimate the log reduction of BCR-ABL rearrangements

  4. It seems to me: Chronic granulocytic leukaemia in accelerated phase (impending blast transformation)

    or an Basophilic leukaemia.

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