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PERIPHERAL BLOOD COUNTS:
HB: 8.1 G/DL
HCT: 27.0 %
MCV: 101.5 FL
MCH: 30.5 PG
WBC: 7.9 x 10E9/L
ANC: 1.2 x 10E9/L
PLATELETS: 38 x 10E9/L
PERIPHERAL BLOOD FILM: Dimorphic blood picture. Shows anisocytosis and macrocytosis. 75% blast cells seen. Platelets are low on film.
BONE MARROW ASPIRATE: Hypercellular specimen predominantly exhibiting granulocytic hyperplasia. M:E ratio is 40:1. Features of dysmyelopoiesis in the form of giant cells are also noted. Megakaryocytes seen. 3% blast cells seen. No non-hematopoietic clump or hemoparasite identified on the stained smear examined.
BONE TREPHINE TOUCH PREP: Thick, hypocellular touch imprint.
BONE TREPHINE (H&E) SECTIONS: Good length specimen showing intact architecture, area of fibrosis and hypercellularity for age. Overall cellularity is around 90-95%. Cellular areas show granulocytic hyperplasia with relatively suppressed erythroid precursors. Adequate megakaryocytes seen. No granuloma identified in the sections examined.
RESULTS OF IMMUNOHISTOCHEMICAL STAINS:
CD34 : Negative
TDT : Negative
CD3 : Reactive (highlighting normal T-cell population)
CD20 : Negative
RESULTS OF RETICULIN STAIN: Shows grade MF-II reticulin fiber pattern.
OPINION: Peripheral film shows 75% blasts while only 3% blast on aspirate and lymphohistiocytic background on trephine with inconclusive immunohistochemistry. Findings of aspirate doesn't correlate with the peripheral and as well as trephine.
Suggest a repeat good length trephine along with cellular aspirate for proper evaluation, which will be charged on the same HN number free of charge.
DR. MUHAMMAD SALMAN ARIF, DR. NATASHA ALI,
M.B.B.S F.C.P.S (HAEMATOLOGY),
RESIDENT HAEMATOLOGY CONSULTANT HAEMATOLOGIST
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