70 yr male presented with generalized weakness and abdominal distension since 7m TLC: 20,000 HB: 10.2 plt: 65,000 comment on peripheral smear


Morphology Favours AML M4 Subtype Most of The Cells Appear Of Monocytic Lineage - Promonocytes - Indented Nuclear Margins , Abundant gray blue cytoplasm , Cytoplamsic Vacuoles ( Image 3) Monoblasts ( Image2,3, 5) Adv - Flow Cytometry
Thanks all.esp to dr mohit and dr potdar. Indeed a difficult case
MDS/MPN favours atypical chronic myeloid leukaemia
Sir.what is MPN?

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Atypical mononuclears.with 1.2 nucleoli.indented chromtic nuclei.adeqate cyroplasm. Occ metamylocytes ..some neutrophils in background. POSSIBILITY.. SPILLOVERS (BUTTOCK CELLS OR REIDER CELLS WITH NOTCHED NUCLEI)IN NHL PROLYMPHOCYTIC LKMIA. AML..M4. plt. low.. sugg.cli6 correlation. ihc.l.nd biopsy.
@Dr. Mohit Rajpal Sir the lab i work in , doesn't have flowcytometry or special stains ..so we referred the case to higher centre ..with a diagnosis suggestive of myeloproliferative neoplasm ( possibly CML)
Shift to left up to metamyelocytes, look for basophils...since splenomegaly is present so advise bone marrow.low possibility of leukemoid reaction as splenomegaly is present..more in favor of MPN/ MDS
@Dr. Mm Bandhaypadhya Thanku Sir @Dr. Tusheeta J Mam Please Updatw Us with The Diagnosis of the case Thanku
On follow up, this case was diagnosed as CML ( chronic phase ) at higher centre...
Myloid series is evident with monocytic series and many mature side (band and neutro) .... I would go for MDS/MPN ..... CmmL.
This case may be an atypical CML. In atypical CML count may be low with minimal basophilia.Hypogranular myeloid cells seen.
Is it common to have a tlc oc 20k.and low plt in cml? Myelocytes and metamylocytes are alo few. Opinion from learned house
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