B-precursor-ALL of common (c)-ALL subtype - case report 1

Author(s): S. Fruehauf, A. Pitkus, J. Dengler, S. Kraeker
Last change: 2003/04/10

Sort of case report: in clinical view

Medical history: The patient complained about a decreasing state of health and saw her regular doctor. The doctor noted a leukocytosis of 25.7 / nl and the patient was referred to our institution. As part of our initial investigation 14 days later, a complete blood count (CBC) revealed a leukocytosis of 44.6 /nl and lymphocytosis of 13.8 /nl, as well as 70% Blasts in the differential.

Clinical Examination: A bone marrow analysis was ordered 4 days later and the accompanying CBC results are shown below.

Laboratory results:

Parameter	Value	Normal value [unit]
RBC	3.1	4.0-5.2 /pl
Hemoglobin	10.1	12.-15. g/dl
Hematocrit	0.29	0.36-0.47 l/l
MCV	93	83-97 fl
Plt	215	150-440 /nl
WBC	23.07	4.0-10.0 /nl
Neutrophils	2.08	1.8-7.7 /nl
Monocytes		0.2-0.8 /nl
Lymphocytes	4.84	1.0-4.8 /nl
Eosinophils		0-0.5 /nl
Differential	Results
Band Neutrophils		3-10 %
Segmented Neutrophils	9	50-70 %
Lymphocytes	21	25-40 %
Atypical Lymphs		0 %
Monocytes		2-9 %
Eosinophils		2-4 %
Basophils		0-1 %
Metamyelocytes		0 %
Myelocytes		0 %
Promyelocytes		0 %
Blasts	70	0 %
Normoblasts	1	/ 100 L
Bone Marrow	Differential	Results
Megakaryocytes	2-4%
Lymphoblasts	80%
Lymphocytes	10%

Molecular genetics (incl. Southern blot, PCR): Molecular diagnostic testing performed on the patient's day at our institution showed a bcr-abl rearrangement of the M-BCR-Type (e1 a2).

Diagnosis: A diagnosis of acute lymphoblastic leukemia of common ALL type with the aberrant expression of a myeloid antigen is made.