Case 96 – update 3

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.

Questions:

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?

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