|
Autor*: A. Buliková, J. Kissová
Description:
74 years old man comes to hospital with short history of fever higher than 38°C and bleeding symptoms. CBC shows really high white blood cell count (WBC 193 G/l), severe anaemia (Hb 69 g/l) and thrombocytopenia (PLT 7 G/l). Peripheral blood smears finds considerable numbers of circulating blasts (89%). The blasts represent dominant population of all nucleated cells also in bone marrow smears (95%). Myeloperoxidase staining is positive in more than 3% of these blasts. Flow cytometry confirm myeloid origin of the blasts it means myeloblasts. If they are fulfil another criteria (maturing granulocytic component < 10%, maturing monocytic component < 10%), final diagnosis in patient is acute myeloblastic leukaemia without maturation (AML M1 in FAB classification).
Zařazení*:
Acute myeloid leukaemia without maturation
Přílohy*:
Description: Myeloblasts in peripheral blood smear represent dominant population. These are large cell, they have high nucleocytoplasmic ratio. Their nucleus has diffuse fine chromatin pattern and one or more nucleoli. The cytoplasm is moderately basophilic in this case and do not contain any granulation. 
Description: Another picture of the myeloblast in the patient with AML without maturation. Number of the cells at the field of view confirms high leukocyte count which is find by cell blood analyser. Appearance of the cells is same as in previous picture. 
Description: There are nine myeloblasts and two lymphocytes (5 and 10 o'clock) in the picture. Comparison of the chromatin pattern in these two type of the cells confirm really fine chromatin in myeloblasts. 
Description: There are myeloblasts of various size in peripheral blood. No other cell types are find. 
Description: Almost only myeloblasts are detected in peripheral blood. They are various size with moderate to almost strong basophilic cytoplasm without any granulation. 
Description: Bone marrow is rich and infiltrated by uniform population of myeloblasts. There are only two lymphocytes (in the middle and at 6 o'clock) there; they can be distinguished by mature chromatin and markable smaller cell¨s size. One promyelocyte - large cell, ex-centric nucleus, numerous azurophilic granulation - is at the bottom of the picture (8 o'clock). 
Description: There are numerous myeloblasts with fine nuclear chromatin, one to four nucleoli, moderately basophilic cytoplasm without granulation. No other more mature cells of granulocytic lineage are find. One cell of erythroid lineage is at 7 o'clock. 
Description: Hypercellular bone marrow with dominant population of myeloblasts. Only one segmented neutrophil is above the picture's centre, it is hypogranular. There is also one mature plasmocyte at 11 o'clock. Due to rich smear not all cells can be definitely distinguished. 
Description: There are the most negative cells in myeloperoxidase staining. But three immature cells in the picture (at left) are cleary positive. One positive cell at right is more mature (metamyelocyte or even band) and cannot be count in numer of positive blasts.