CWM Hospital Fiji School of Medicine Depts. of Medicine

1
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 20/6/2002

• Acute Monocytic Leukemia (AML-M5b)

2
History

• 26 Year Fijian female admitted to AE
• Severe weakness, fever since 1week
• Shortness of Breath, Tachycardia
• Liver 12cm, spleen palpable, Jaundice
• Multiple petechiae
• Past family history nil significant.

3
Full Blood Count

• Hemoglobin 7.2
• MCV 124
• WBC 129,000
• PLT 45,000
• Differential - ?
• Patient died on second day of admission.
  ?Internal bleeding and CVS collapse.

4
Blood Smear

• Increased WBC, (Blue dots)
• Large cells with irregular lobulated nuclei

5
Blood Smear-Blast Morphology

• Irregular folded nucleus
• Insignificant nucleoli
• Abundant Grey-blue cytoplasm (maturation)
• No granules.

6
Blood Smear-Blast Morphology

• Irregular folded nucleus
• Insignificant nucleoli
• Abundant Grey-blue cytoplasm (maturation)
• No granules.

7
Blood Smear-Blast Morphology

• Irregular folded nucleus
• Insignificant nucleoli
• Abundant Grey-blue cytoplasm (maturation)
• Some cells show pink/red granules (Myeloid
  differentiation)

8
Blood Smear-Blast Morphology

• Irregular folded nucleus
• Abundant Grey-blue cytoplasm (maturation)
• Some cells show pink/red granules (Myeloid
  differentiation)

9
Blood Smear-Blast Morphology

• Irregular folded nucleus
• Abundant Grey-blue cytoplasm (maturation)
• Some cells show pink/red granules (Myeloid
  differentiation)

10
Discussion

• Typical presentation of Acute Myelocytic
  Leukemia AML-M5b.
• Middle age
• Very high WBC counts - Blasts
• Tissue infiltration typically skin, mucosa,
  gingiva more common
• More common Liver and spleen enlargement
• More common fatal outcome.

11
Acute Monocytic Leukemia

• 10 of AML, Young Adults, children.
• Higher prevalence of extra medullary tumors in
  the skin, gingiva, GIT, CNS etc. than other types
  of AML (30 lt5)
• Hepatomegaly and spleenomegaly common
• High leukocyte count in majority of patients.
• Blasts may be mature monocytic (M5a) or
  immature Monoblastic (M5b)

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Acute Monocytic Leukemia

• Large folded nucleus, scanty grey-blue cytoplasm,
  minimal granules.
• Auer rods are rarely seen in monoblastic type
• Often associated with t(911), t(917)
• Clinically DIC is common due to release of
  lysozymal enzymes. Blasts are CD14 ve.
• CNS involvement and meningeal infiltration common.