AML M4 FAB: Acute myelomonocytic leukemia - case report 2

Author(s): S. Fruehauf, A. Pitkus
Last change: 2004/04/10

Sort of case report: In clinical view

Medical history: The patient had been experiencing symptoms of night sweats, fear and powerlessness, a weight loss and difficulty in breathing for two months prior to visiting another institution. Initial testing indicated an acute myeloid leukemia and the patient was transferred to our institution for further diagnostic testing and treatment.

Clinical Examination: A bone marrow analysis (including hematopathology and cytochemical staining), immunophenotyping and the accompanying complete blood count (CBC) were performed by our institution. Hematopathology, molecular diagnostics and cytogenetics were also performed the same day at another institution according to a study protocol.

Laboratory results:

Parameter	Value	Normal value [unit]
RBC	3.2	4.0-5.2 /pl
Hemoglobin	9.9	12.-15. g/dl
Hematocrit	0.28	0.36-0.47 l/l
MCV	88	83-97 fl
Plt	87	150-440 /nl
WBC	34.76	4.0-10.0 /nl
Neutrophils	17.03	1.8-7.7 /nl
Lymphocytes	6.26	1.0-4.8 /nl
Monocytes	4.52	0.2-0.8 /nl
Eosinophils		0-0.5 /nl
Differential	Results
Band Neutrophils	4	3-10 %
Segmented Neutrophils	45	50-70 %
Lymphocytes	18	25-40 %
Atypical Lymphs		0 %
Monocytes	13	2-9 %
Eosinophils		2-4 %
Basophils		0-1 %
Metamyelocytes	9	0 %
Myelocytes	5	0 %
Promyelocytes		0 %
Blasts	6	0 %
Normoblasts	1	/100

Cytogenetics: Cytogenetics testing indicates that the patient has a normal karyotype.

Molecular genetics (incl. Southern blot, PCR): Molecular Diagnostics testing for the typical changes characteristic of an acute myeloid leukemia are negative. These markers, AML1-ETO, PML-RARA, and CBFb-MYH11, were tested by PCR methods. In addition, testing for a FLT3-ITD mutation are negative.

Diagnosis: Acute myeloid leukemia of the M4 subtype

Differential diagnosis: Acute myeloid leukemia of the M5 subtype, acute myeloid leukemia of the M5a subtype