AML-MRC with Basophilia Mimicking CLPD Due to Abnormally Clumped Chromatin
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AML-MRC with Basophilia Mimicking CLPD Due to Abnormally Clumped Chromatin Huifeng Shang1 • Ruimin Li2 • Xiaolei Chai3 • Xueyan Chen4 • Keyu Liu3
Received: 5 February 2020 / Accepted: 4 June 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
A 49-year-old man sought medical attention with a 1-month history of fatigue and intermittent fever. He manifested no hepatosplenomegaly and no lymph node enlargement. Laboratory studies were remarkable for leukocytosis, anemia and thrombocytosis (white blood cells 110 9 109/L, hemoglobin 73 g/L, platelets 636 9 109/L, basophils 4.8 9 109/L) Peripheral blood smears showed 80% mononuclear cells with abnormally clumped nuclear chromatin without prominent nucleoli, alongwith increased mature basophils. (Fig. 1a–d). Bone marrow smears revealed large amounts of mononuclear cells infiltration mimicking mature lymphocytes with abnormally clumped chromatin, basophilia and megakaryocyte dysplasia, which was characterized by the presence of micromegakaryocytes, megakaryocytes with small round nuclei and multiple round nuclei (Fig. 1e–h). Peripheral blood and bone marrow smears were re-stained to avoid the influence of improper dyeing and the result was the same as before. Flow cytometry using CD45 vs SSC gating strategy revealed an abnormal blast population and basophilia. The blast population was positive for
& Keyu Liu [email protected] 1
Department of Clinical Laboratory Medicine, Shanxi Bethune Hospital and Shanxi Academy of Medical Sciences, Taiyuan, China
2
Departments of Clinical Laboratory, Handan Central Hospital, Handan, Hebei Province, China
3
Department of Clinical Laboratory, Affiliated Hospitsal of Engineering University of Hebei, Handan, Hebei Province, China
4
Department of Clinical Laboratory, The People’s Hospital of Longhua, Shenzhen, Guangdong Province, China
CD13, CD33, CD34, CD36, HLA-DR, CD117 and MPO. The basophils were positive for CD123 and CD11b, the blasts being negative for these markers. Besides, the basophils were positive for HLA-DR(Fig. 2). The patient had no prior history of chronic myeloid leukemia, and his BCR/ABL fusion gene was negative using RT-PCR method. Cytogenetic analysis of the BM cells indicated a 46,XY,t(4;12)(q12;p13)[20] karyotype. Due to the high ratio of blood and marrow blasts and dysplasia of myeloid and megakaryocyte, the patient was diagnosed with acute myeloid leukaemia with myelodysplasia related changes (AML-MRC) according to WHO classification [1-2]. The patient received treatment with DA (daunorubicin and cytarabine) protocol after the diagnosis was rendered, and achieved complete remission (CR) after 2 cycles of chemotherapy. Basophilia in acute myeloid leukaemia may result in two potential differential diagnoses, namely, chronic myeloid leukemia- myeloid blast crisis (CML-MBC) and acute basophilic leukemia (ABL). A short duration of disease, absence of a prior history of chronic myeloid leukemia, no splenomegaly, and an absence of the Philadelphia chromosome/BCR-ABL fusion gene favored the diag
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