Let’s begin with the patient’s complete blood count (CBC) at the time of admission:
What’s what: WBC, white blood cell count; Hb, hemoglobin; MCV, mean cell volume; MCHC, mean cellular hemoglobin concentration; RDW-SD, red cell distribution width-standard deviation; platelets, PLT; Normal values: WBC 5-10 x 109/L, RBC 4-6 x 1012/L, Hb 12-16 g/dL, Hct 35-47%, MCV 80-100 fL, MCHC 32-36 g/dL, RDW-SD < 45%, platelets (PLT) 150-450 x 109/L
True or false: given that her total white blood cell (WBC) count is normal, there is no need to obtain a WBC differential (i.e., we can assume it will be normal).
Here is the white blood cell differential:
Here is the peripheral blood smear:
A number of other blood tests were performed but let’s jump to the bone marrow examination (next slide).
Here is the bone marrow aspirate:
Food for thought (we will return to these questions):
- What is your differential diagnosis?
- Can you make a definitive nosological diagnosis from examination of the marrow smear alone?
- What other tests would you order?
Because of the severity of SOB a chest CT was obtained.
Results of BAL:
[Ask user to describe or simply have German describe]
- Acute myeloid leukemia with inv(16)(p13;q22) and CBFB/MYH11 [German, we may want to include a slide about testing with FISH/cytogenetics before giving away diagnosis]
- Pulmonary leukostasis
Key observation: abnormal eo-baso precursors with cytoplasmic granules two to three times bigger than normal + blast (number of blasts or eo-baso precursors does not matter)