The blood film has been reported: – leukocytosis with neutrophilia and monocytosis, there is left shift and toxic granulation and vacuolation. Occasional primitive cells ~ 2%. No nucleated RBCs. The appearances might be reactive/infection related, and infection as well as primary immune deficiency work up might be relevant. Dysplasia is also possible and a bone marrow examination is advisable.
You check his haematinics, B12 & folate & ferritin are all normal. His immunoglobulins are normal.
The haematology team carry out a bone marrow biopsy and you have the following bone marrow aspirate slides and flow cytometry results.
He is stable in himself, but his platelet count is dropping slowly.
1. What are your interpretation of these results? Is bone marrow biopsy diagnostic? What specific cell markers are you looking for on FLOW?
2. Do you always expect abnormal cytogenetics? What are the implications of variations molecular abnormalities ?
3. What other factors are important in prognostication?
4. Does he need any other specialty input?
Join us on Twitter @TeamHaem and let us know what your thoughts are, what questions you have and what you want to do as we see this case evolve over the next week.
Remember to use #teamhaem on all your posts to help us follow the case! Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality. TeamHaem are not a position of authority. It is an educational platform to allow discussion and learning.