A Hematology Case Study about Leukemia by Sarah Wycoff ALL in a Days Work…
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Transcript of A Hematology Case Study about Leukemia by Sarah Wycoff ALL in a Days Work…
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A Hematology Case Study
about Leukemia by
Sarah Wycoff
ALL in a Days Work…ALL in a Days Work…
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Questions to Consider:
1. How do you accurately determine a leukemic blast cell from a lymphocyte?
2. What cytochemical stains can be used to diagnose Acute Lymphoblastic Leukemia?
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Patient History 50-year-old female No prior medical problems Admitted to ER with chest pain,
fatigue and shortness of breath
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CBC and Differential ResultsWBC: 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)
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Peripheral Blood Smear Normal
lymphocyte in the middle
4 blast cells in the corners
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Bone Marrow Aspirate Cellularity is
increased at 95-100%
Normal hematopoietic marrow is replaced by an immature lymphoid infiltrate
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Normal Bone Marrow
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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
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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
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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
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Diagnosis: Acute Lymphoblastic Leukemia (ALL)
Regarded as a childhood disease (80% of cases occur between the ages of 2 to 10)
ALL subtypesT-Cell - 20-25%Precursor B-cell (L1 and L2) – 70-75%Mature B-cell (Burkitt – L3) – 5%
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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)
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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
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Treatment Chemotherapy with
Cyclophosphamide, Mesnex, Viacritine, Doxorubican and Decadron
Transferred to University of Michigan Medical Center to receive a bone marrow transplant
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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
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Answers to Questions to Consider1) Blasts have a higher nucleus to
cytoplasm (N:C) ratio and finer chromatin pattern than normal lymphocytes
2) Cytochemical stains used to diagnosis Acute Lymphocytic Leukemia:
• MPO negative• SBB negative• PAS positive
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CreditsThis 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.