Dept of Medicine

1
Dept of Medicine Pathology CWM Hospital Fiji
School of MedicineWeekly CPC Meeting
12 Sept 2002 34 Year male with pallor and gum
bleeding. (AML M5a Variant)
2
Clinical Details

• 34 year Male Fijian
• Pallor, gum bleeding on brushing, gum swelling,
  ulcers.
• Persisting sores over legs and ankle 2w.
• Weakness, Shortness of breath.
• O/E
• Supraclavicular, axillary LN palpable.
• Spleen palpable moderate, No Liver enl.

3
Complete Blood Count

• Hb 9.2
• RBC 2.82
• WBC 48,000
• PLT 119,000
• MCV 98.9
• HCT 27.9
• Blood film abnormal cells

4
Blood Film

• High WBC count.
• Larger cells
• (compared to RBC)

5
Blood Film

• Large cells
• Blue cytoplasm with Convoluted large nucleus.
  (monocytoid)
• Occassional ones show pink cytoplasm (myeloid)

6
Blood Film

• Large cells
• Blue cytoplasm with Convoluted large nucleus.
  (monocytoid)

7
Blood Film

• Large cells
• Blue cytoplasm with Convoluted large nucleus.
  (monocytoid)
• Occassional ones show pink cytoplasm (myeloid)
• Occassional more immature forms darker, little
  cytoplasm, large nucleus with nucleolus
  (monoblasts)

8
Discussion

• Abnormal cells of predominantly Monocytoid
  nature.
• Platelets moderately decresed
• Gum hypertrophy and bleeding
• Moderate Spleen and Lymphnode enlargement.
• Middle age
• Are all features of AML-M5 (monocytic)