1- What features of the differential resemble chronic myeloid leukemia (CML)? What helps to distinguish this case from CML? 2- Which of the hematopoietic cell lines exhibit dyshematopoiesis in the bone marrow? 3- How would you classify the bone marrow cellularity? Why?

Basic Clinical Laboratory Techniques 6E
6th Edition
ISBN:9781133893943
Author:ESTRIDGE
Publisher:ESTRIDGE
Chapter2: Basic Hematology
Section2.4: The Hemacytometer
Problem 8RQ
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Hancock, a 65-year-old white male, was seen in triage with complaints of fatigue, malaise, anorexia, and hemoptysis of recent onset. A complete blood count (CBC) was ordered and revealed anemia and a shift to the left in granulocytes. Hematopoietic cells showed dysplastic features. Consider diagnostic probabilities and reflex testing that could provide differential diagnostic information.

The results of the CBC on Hancock were:

The neutrophilic cells show marked hyposegmentation and hypogranulation. Red blood cell (RBC) morphology includes anisocytosis and poikilocytosis, teardrop cells, ovalocytes, and schistocytes.

1- What features of the differential resemble chronic myeloid leukemia (CML)? What helps to distinguish this case from CML?

2- Which of the hematopoietic cell lines exhibit dyshematopoiesis in the bone marrow?

3- How would you classify the bone marrow cellularity? Why?

4- Identify at least two features of the bone marrow that are compatible with the diagnosis

5- What chemistry tests would be helpful to rule out megaloblastic anemia?

6- How would you treat this particular patient?

The results of the CBC on Hancock were:
RBC
1.60 x 1012/L WBC Differential
Hb
5.8 g/dL (58 g/L) 44% segmented
neutrophils
7% band neutrophils
6% lymphocytes
28% eosinophils
1% metamyelocytes
1% myelocytes
9% promyelocytes
Hct
0.17 L/L (17%)
10.5 x 10/L
39 x 10/L
0.8%
WBC
Platelets
Reticulocyte
count
4% blasts
Transcribed Image Text:The results of the CBC on Hancock were: RBC 1.60 x 1012/L WBC Differential Hb 5.8 g/dL (58 g/L) 44% segmented neutrophils 7% band neutrophils 6% lymphocytes 28% eosinophils 1% metamyelocytes 1% myelocytes 9% promyelocytes Hct 0.17 L/L (17%) 10.5 x 10/L 39 x 10/L 0.8% WBC Platelets Reticulocyte count 4% blasts
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