AML M5a FAB: Acute monocytic leukemia with predominantly monoblasts - case report 2

Author(s): S. Fruehauf, A. Pitkus, J. Dengler, S. Kraeker
Last change: 2004/08/19

Sort of case report: In clinical view

Medical history: The patient was being seen elsewhere for prenatal visits and a subsequent investigation of nightsweats. Complete blood count results (CBC) showed a leukocytosis of over 150 /nl and an anemia. The patient was later transferred to our department for further investigation of hematological abnormalities and development of respiratory insufficiency.

Clinical Examination: A bone marrow biopsy was ordered and the accompanying complete blood count (CBC) results are shown below.

Laboratory results:

Parameter	Value	Normal value [unit]
RBC	3.4	4.0-5.2 /pl
Hemoglobin	10.2	12.-15. g/dl
Hematocrit	0.30	0.36-0.47 l/l
MCV	87	83-97 fl
Plt	119	150-440 /nl
WBC	158.50	4.0-10.0 /nl
Neutrophils	1.59	1.8-7.7 /nl
Monocytes		0.2-0.8 /nl
Lymphocytes	1.59	1.0-4.8 /nl
Eosinophils		0-0.5 /nl
DIfferential	Results
Band Neutrophils		3-10 %
Segmented Neutrophils	1	50-70 %
Lymphocytes	1	25-40 %
Atypical Cells	98	0 %
Monocytes		2-9 %
Eosinophils		2-4 %
Basophils		0-1 %
Metamyelocytes		0 %
Myelocytes		0 %
Promyelocytes		0 %
Blasts		0 %
Normoblasts		/100 L

Cytogenetics: Cytogenetics testing including karyotyping was attempted on a bone marrow specimen analyzed elsewhere. However, with the absence of metastases, karyotyping was not possible.

Other molecular diagnostics: FISH analysis showed 2 cell clones, a trisomy 8 t(9;11)(p21;q23), and the other was a tetrasomy 8, t(9;11), (p21;q23).

Diagnosis: Immunophenotyping is consistent with an acute myeloid leukemia of the M5 subtype with a MLL gene arrangement.

Differential diagnosis: Acute Myeloid Leukemia of the M5a subtype