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ALL in a Days Work…. A Hematology Case Study about Leukemia by Sarah Wycoff. Questions to Consider:. How do you accurately determine a leukemic blast cell from a lymphocyte? What cytochemical stains can be used to diagnose Acute Lymphoblastic Leukemia?. Patient History.

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all in a days work

ALL in a Days Work…

A Hematology Case Study

about Leukemia

by

Sarah Wycoff

questions to consider
Questions to Consider:
  • How do you accurately determine a leukemic blast cell from a lymphocyte?
  • What cytochemical stains can be used to diagnose Acute Lymphoblastic Leukemia?
patient history
Patient History
  • 50-year-old female
  • No prior medical problems
  • Admitted to ER with chest pain, fatigue and shortness of breath
cbc and differential results
WBC: 20.5 bil/L (4.3-10.9)

Neutaphils: 1.84 (7.0-7.2)

Lymphocytes: 4.10 (1.1-4.5)

Monocytes: 0.21 (0.0-0.8)

Myelocytes: 0.21 (0.0)

Blast: 14.14 (0.0)

Reticylocytes: 17 bil/L (25-85)

RBC: 3.16 tril/L (3.87-5.05)

HgB: 10.4 (12.1-15.0)

MCV: 91.8 fl (80-100)

MCHC: 35.9% (33-35)

RDW: 18.1% (11.5-15.0)

Platelets: 31 Bil/L (155-442)

CBC and Differential Results
peripheral blood smear
Peripheral Blood Smear
  • Normal lymphocyte in the middle
  • 4 blast cells in the corners
bone marrow aspirate
Bone Marrow Aspirate
  • Cellularity is increased at 95-100%
  • Normal hematopoietic marrow is replaced by an immature lymphoid infiltrate
cytochemial stains sbb sudan black b
Cytochemial Stains- SBB(Sudan Black B)
  • Positive control cell is the mature neutrophil (granulocytic cell line)
  • Stain determines if blasts are granulocytic
  • Patient’s blasts are negative
cytochemial stains mpo myeloperoxidase
Cytochemial Stains- MPO(Myeloperoxidase)
  • Positive control cell is the mature neutrophil

(granulocytic cell line)

  • Stain determines if blasts are granulocytic
  • Patient’s blasts are negative
cytochemical stains pas periodic acid shiff
Cytochemical Stains- PAS(Periodic-Acid Shiff)
  • Positive control cells are the lymphocytic cell line and neutrophils
  • Stain will be positive in lymphocytic and erythrocytic blasts
  • Patient’s blast are slightly positive
diagnosis acute lymphoblastic leukemia all
Diagnosis: Acute Lymphoblastic Leukemia (ALL)
  • Regarded as a childhood disease (80% of cases occur between the ages of 2 to 10)
  • ALL subtypes

T-Cell - 20-25%

Precursor B-cell (L1 and L2) – 70-75%

Mature B-cell (Burkitt – L3) – 5%

clinical manifestations of all
Clinical Manifestations of ALL
  • Malaise, fatigue and pallor –related to anemia (too few RBC’s)
  • Bruising, petechiae and epitaxis – related to thrombocytopenia (too few PLT’s)
  • Weight loss, bone pain and sternal tenderness (due to proliferation of leukemic cells in bone marrow)
philadelphia chromosome
Philadelphia Chromosome
  • Commonly associated with CML (95% are Ph +)
  • 15% to 30% of adults with ALL are Philadelphia chromosome positive, making it the most common ALL associated chromosomal abnormality
treatment
Treatment
  • Chemotherapy with Cyclophosphamide, Mesnex, Viacritine, Doxorubican and Decadron
  • Transferred to University of Michigan Medical Center to receive a bone marrow transplant
summary
Summary
  • 50 year-old female admitted to ER
  • Laboratory findings suggestive of adult ALL
  • Diagnosis confirmed though cytochemisty and flow cytometry
  • Transferred to University of Michigan to receive bone marrow transplant
answers to questions to consider
Answers to Questions to Consider
  • Blasts have a higher nucleus to

cytoplasm (N:C) ratio and finer chromatin pattern than normal lymphocytes

  • Cytochemical stains used to diagnosis Acute Lymphocytic Leukemia:
    • MPO negative
    • SBB negative
    • PAS positive
credits
Credits

This case study was prepared by

Sarah Wycoff, MT(ASCP)

while she was a Medical Technology student in the

2004 Medical Technology Class at

William Beaumont Hospital in Royal Oak, MI.

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