Hematopathology

8 years male, fever since 15 days, wbc count -32800 /cumm , platetets adequate.kindly comment

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Leucocytosis. Atypical nucleolated mononclears.. indented.. nucleus.... irregular cytoplasmic outlines... basophilic cytoplasm. Dd. Blasts vsTranformed.. monocytoid lymphocytes. Sug.clinical correlation Folow up study... repeat cbc aftee s week. Special stai s.. immunochemistry. Flowcytometry.... cell markerstudy... bone marrow study.... Mlnospot test... and cytogenetic study.. for conclusive diagnosis.
Valuable opinion
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Leucocytosis with lymphcytosis Atypical lymphocytes with monocytoid morphology and blasts. DD Lymphoid leukemoid reaction Subleukemic leukemia Adv Bone marrow study Serology for viral diseases Look for viral stigmata like pneumonia MMR Whooping cough Any drugs history like phenytoin Lymphadenopathy Organomegaly etc to be looked for
I agree sir. My teachers used to say.... one must think twice if not more before declaring a blood report as leukemia. It is as ominous as issuing a death certificate. Leukemia mimics/blast mimics must be ruled out. Thorough clinical evaluation is mandatory. We are lucky to have Immunochemistry or fcm. Those days only few special stains were available. It is wise to have a conservative approach.
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Medium to large sized blasts with scant agranular cytoplasm, irregular cleaved nuclei, indistinct nucleoli in few. Suggestive of Acute leukemia, possibly lymphoid. Advised immunophenotyping.
Thank you doctor
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Blasts with occasional cleaved nuclei. Distinc neucleoli few of them. Agranular cytoplasm. Acute leaukamia. ( Hypogranular variant of APML) Suggest: BMA and IPT by Flocytometry.

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Clear cut blast seen....need further evaluation... Leukemia ..
Marked Leukocytosis. Acute Leukemia. Advised BMA/FCM.
Acute Leukemia ? ALL Adv: BMA, FCM
Thank you doctor
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Lymphocytosis