CWM Hospital Fiji School of Medicine Depts' of Medicine

1
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 28/2/2002

• Acute Leukemia

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History

• 24 Year old Fiji Indian female
• Anemia not responding to Hematenics since many
  weeks. Referred to CWM hospital.
• O/E patient in moderate cardiac failure.
• CBC showed anemia with abnormal cells
• Patient died after 2 days

3
Blood Smear

• Lymphocytes (normal)
• Large Blasts
• Platelets
• RBC

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Blood Smear

• Lymphocyte (normal)
• Large Blast cell (note pale cytoplasm, no
  granules, large nucleus) Large Nucleoli
• Platelet

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AML- Blood Smear

• Lymphocyte (normal)
• Large Blast cell
• Platelet
• Large Nucleoli

6
Blood Smear

• Neutrophil (normal)
• Large Blast cell
• Platelet
• Note Large Nucleoli

7
Blood Smear

• Nucleated RBC
• Large Blast cell
• Platelet
• Note Large Nucleoli

8
Blood Smear

• Large Blast cell
• Note Auer Rod (crystal shaped inclusion in
  cytoplasm)
• Platelet
• Note Large Nucleoli

9
Blood Smear

• Large Blast cell
• Note Auer Rod (crystal shaped inclusion in
  cytoplasm)
• Platelet
• Note Large Nucleoli

10
Blood Smear

• Large Blast cell
• Note Auer Rod (crystal shaped inclusion in
  cytoplasm)
• Platelets
• Note Large Nucleoli

11
Blood Smear

• Large Blast cell
• Note Auer Rod (crystal shaped inclusion in
  cytoplasm)
• Platelets
• Note Large Nucleoli

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Discussion

• In view of large blasts with large irregular open
  nucleus, prominent multiple nucleoli, pale
  abundant non granular cytoplasm, and some blasts
  showing Auer rods.
• Possibility of
• 1. Acute Myeloid Leukemia Promyelocytic
  (AML-M3v) Microgranular variant.
• 2. Acute Lymphocytic leukemia ALL-L2
• Special stains and further study ?? (post mortem)

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AML-M3 / Promyelocytic Leuk.

• 10 of Acute Myelocytic leukemias
• DIC Hemorrhage - very common due to
  fibrinolysis by enzymes of promyelocyte granules.
• Both skin, mucosa and internal bleeds.
• Thrombocytopenia is usually moderate.
• Plenty of primary myeloid granules in cytoplasm.

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AML-M3 / Promyelocytic Leuk.

• 1-10 of blasts show crystal cytoplasmic
  inclusions of primary myeloid granules Auer
  Rods. Some blasts may show multiple rods.
• 20 cases show few or no granules known as
  Microgranular variant (AML - M3v)
• Strong positive staining by Sudan black and
  myeloperoxidase stain suggests myeloid nature of
  blasts, (lymphoid blasts do not show staining).

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AML-M3 / Promyelocytic Leuk.

• Unlike other leukemias, Blast cells mature in
  response to all-trans retinoic acid therapy.
• Karyotype abnormality is usually a translocation
  - t(1517)
• Clinical course in microgranular variant (M3v) is
  not different than usual type M3.