Case Study (2)- Chronic Myeloid Leukemia (CML)
History:
37-year-old female. History of fibrocystic breast disease. Seen for routine workup before breast biopsy.Physical Examination:
Moderate splenomegaly.No other organomegaly
Laboratory Investigations:
1. CBC: (with microscopic differential)
RBC 4.27 x 1012/LHGB 13.5 g/dL
HCT 41.2 %
MCV 96.3 fL
MCH 31.3 pg
MCHC 32.5 g/dL
WBC 133.6 x 109/L
N seg 56 %
N band 15 %
N metamyelocytes 13 %
N myelocytes 4 %
N promyelocytes 3 %
L 3 %
M 4 %
E 1 %
Blasts 1 %
PLT 416 x109/L
Morphologic Alterations
Results of the blood smear exam were:RBC morphology: Normocytic, normochromic
WBC morphology: Mature stages and precursors all within normal morphologic limits.
PLT morphology: Within normal limits
2. Bone marrow examination:
Aspirate differential (1000 cells):Erythroblasts 9.9%
Myeloblasts 1.1 N
promyelocytes 1.4 N and precursors 71.7L 2.0M 2.8E and precursors 2.2 B and precursors 8.9
Sections: Markedly hypercellular with increased megakaryocytes.
3. Cytochemistry:
Leukocyte alkaline phosphatase [LAP] score: 3 (RI 64-176)4. Cytogenetics:
46, XX, t (9;22) (q34; q11) (Philadelphia chromosome) seen in all marrow cells analyzed.
Diagnosis:
Chronic Myeloid Leukemia (CML)
Her post-transplant course went well, and 28 days later, her hemoglobin was 11.9 g/dL, WBC 2.0 x 109/L, and PLT 84 x 109/L. Her marrow showed evidence of good engraftment in all three cell lines.
This patient continues to be followed in Hematology Clinic. At last visit, ten years post-transplant, she was doing well and had no evidence of recurrent of the disease. Molecular diagnostic test performed at that time were negative for BCR-abl transcripts.
Clinical Course
Following the standard preparatory regimen, the patient received an allogeneic bone marrow transplant. The donor was her HLA-matched brother.Her post-transplant course went well, and 28 days later, her hemoglobin was 11.9 g/dL, WBC 2.0 x 109/L, and PLT 84 x 109/L. Her marrow showed evidence of good engraftment in all three cell lines.
This patient continues to be followed in Hematology Clinic. At last visit, ten years post-transplant, she was doing well and had no evidence of recurrent of the disease. Molecular diagnostic test performed at that time were negative for BCR-abl transcripts.
- Chronic Myeloid Leukemia (CML) History: 37-year-old female. History of fibrocystic breast disease. Seen for routine worku…){kind=link}
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