45 year male, came to the hospital with the complains of fever since one month, loss of appetite and weight loss to since 1 week. On palpation splenomegaly was found.. no lymph nodes enlarged. CBC revealed Hb- 3.9 gm/dl, TLC- 1.33 lakhs, platelets- 13000 cells .. these are the peripheral smear microscopic picture.. kindly give your views!!!!



Peripheral smear shows features of an Acute leukaemia with more than 90 percent blast population of cells Why not CLL - cell size of blasts is 2 to 3 times that of RBCs , High N : C ratio , immature fine chromatin with prominent nucleoles CML with Blast crisis is a possibility-any known history of CML chronic phase in past ?usually thrombocytopenia not seen in CML Advice Bone marrow aspiration and Trephine Biopsy for further evaluation Flow cytometry is the gold standard for lineage of leukaemia - Myeloid vs Lymphoid though age group favouring AML but no definitive evidence of Auer rods seen in the blasts noted

RBC- microcytic hypochromic Wbc: leucocytosis Mainly blasts are seen having diffuse chromatin and nucleoli (one or more than one) and scant basophils cytoplasm. No Auer rods seen. Few smudge cells seen. Platelets: thrombocytopenia Parasite: not seen in studied smear. O/f/s/o- ACUTE MYELOID leukemia probably M1 /M2. Adv: flowcytometry.

MPO was negative. and diagnosis was given as prolymphocytic leukemia

Yes adult ALL with ph positivity can present with this type of features.

Smear shows.... Rbcs are normocytic to microcytic.... Moderate hypochromia.... Total count is increased... Cells are larger in size....with many cells showing prominent nucleoli... Blast cells are seen.... Mostly myeloid series cells.... Diagnosis..... Acute leukemia.... Most probably.... Myeloid type

Features are suggestive of acute leukaemia. Do cytochemistry and immunophenotyping.

How big is spleen?? Possibility of CML with blast crisis also needs to be considered. MPO staining of PS will help. Followed by flowcytometry on peripheral smear.


Acute Leukemia. Advice BMA& FcM for characterization

Load more answers