Is this Acute Myeloid Leukaemia?

 Patient:  A 45 year old female patient was referred by the GP.
 Presentation: Fatigue, weight loss and recent chest infection, requiring prolonged antibiotics.  
 GP investigation:

 Full blood count revealed the following:-

  • Haemoglobin 9.0
  • Neutrophils 1.2
  • Mean Cell Volume 112
  • White Blood Cells 3.1
  •  Platelets 76
Normal blood ranges:
  • Haemoglobin13-18 g/dL (male) 11.5-16.5 g/dL (females)
  • Neutrophils = 2.5-7.5 X10^9 /L
  • Mean Cell Volume  = 77-95 fL
  • White Blood Cells = 1.3-3.5 X 10^9/L 
  •  Platelets = 150-400 X 10^9/L 

Normal blood ranges

  Haemoglobin :

  • 13-18 g/dL (male)
  • 11.5-16.5 g/dL (females)
  • Neutrophils = 2.5-7.5 X10^9 /L
  • Mean Cell Volume  = 77-95 fL
  • White Blood Cells = 1.3-3.5 X 10^9/L 
  •  Platelets = 150-400 X 10^9/L 

What is the morphology showing?

   
   

Morphology divulges three features:-

  • Erythroid series (red arrows, blood film and 3)
  • Megakaryocytes which are hypolobated, small and micromegakaryocytes (green arrows, blood film 2,3 and 4)
  • Myeloid series, reduced hypogranular maturation and occasional blasts (blue arrows, blood film 1, 2 and 3), monocytes also noted.

Summary of immunophenotyping results

 

AntigensAMLThese results confirm an excess of CD34+ cells (17%) and CD117+ (26%). The flow plots confirm that CD34 and CD117 expression is on myeloid cells, with coexpression of CD13 and CD33, indicating that these are myeloblasts.
There is evidence of myelomonocytic maturation, 49% of cells express CD11b+, 14% of cells express CD14 (mature monocytes), 18% of cells express CD16 (granulocytic).

 

Final diagnosis

The final diagnosis is Acute myeloid leukaemia (AML) with myelodysplasia-related changes.
In the WHO classification there are three possible reasons for assigning cases to this subtype:

  • AML arising from previous MDS or MDS/MPN
  • AML with an MDS-related cytogenetic abnormality
  • AML with multilineage dysplasia

To assign AML to this subtype, dysplasia must be present in at least 50% of the cells in at least two BM cell lines.

For this subtype, the patient should not have been exposed to prior cytotoxic therapy (this would be classified as therapy-related).

What additional information may be prognostically relevant?

Cytogenetics: A molecular technique involving the analysis of the chromosomes in the blood and bone marrow samples from leukaemia patients.