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Hematopathology, Case 4

Hematopathology, Case 4. A 60 year-old male presents with mild fatigue. Physical examination is remarkable for splenomegaly to the level of the umbilicus. CBC WBC 75.1x103/mL Hemoglobin 8.5g/dL Hematocrit 25.5% Platelets 56,000/mL MCV 88.4 femtoliters (fL) RDW 16.1. band.

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Hematopathology, Case 4

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  1. Hematopathology, Case 4 • A 60 year-old male presents with mild fatigue. Physical examination is remarkable for splenomegaly to the level of the umbilicus. CBC WBC 75.1x103/mL Hemoglobin 8.5g/dL Hematocrit 25.5% Platelets 56,000/mL MCV 88.4 femtoliters (fL) RDW 16.1

  2. band myelocyte Promyelocyte (late stage) C B A Describe the findings on the peripheral blood smear

  3. band myelocyte Promyelocyte (late stage) -WBCs are markedly WBCs are markedly increased in number, predominantly cells of the neutrophil series. -Many mature neutrophils are seen as well as earlier forms (A, B, C)

  4. Many of the above white blood cells were also present on the peripheral smear. Identify the cell.

  5. Basophil The basophilic granulocyte is characterized by large, coarse, aggregated dark purple granules. The nuclear lobes are usually not very well visible and masked by the granules

  6. Differential Diagnosis? • While leukocytosis and neutrophilia can be reactive, for example to an infection, the markedly elevated WBC count (>30) and basophilia are not characteristic of an inflammatory process • A bone marrow biopsy was done. The bone marrow was hypercellular with myeloid and megakaryocytic hyperplasia and erythroid hypoplasia

  7. Diagnosis? • Chronic Myelogenous Leukemia (CML)

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