Question

A 43-year-old man is seen by his primary care physician. He complains of excessive tiredness and a lack of stamina in activities he typically performs (e.g., work, sports). He recently noticed excessive bleeding from his gums after brushing his teeth. On physical examination, his physician noted lymphadenopathy and multiple petechiae on his torso, arms and legs. A CBC with differential and a coagulation panel were ordered. The results are as follows:CBC

WBC (x 10⁹/L)       25.0

   RBC (x 10¹²/L)       2.80   HGB (g/dl)       8.4   HCT (%)       24.1

   RBC INDICES       MCV (fl)   86.1

       MCH (pg)   28.9       MCHC (g/dl)   34.9

   RDW (%)       14.2   PLT (x 10⁹/L)       29

DIFFERENTIAL
   WBC identification       Relative (%)           Absolute (x 10⁹/L)           segs           3                   0.8

       lymphs           11                   2.8      

       monos           2                   0.5               eos           0                      0               basos           0                      0

       promyelocytes       76               19.0      

       blasts           8                   2.0                                      

RBC morphology: Normocytic, normochromic; few schistocytes noted

   Platelet estimate   2/ OIF

COAGULATION PANEL

   PT = 16.4 seconds (reference range 11.0–13.0 seconds)

   APTT = 42.0 seconds (reference range 21.0–35.0 seconds)

   TT = 15.2 seconds (reference range 7.0–12.0 seconds)

   FIBRINOGEN = 78 mg/dL (reference range 200–400 mg/dL)

QUESTIONS

   1. Identify the abnormal results seen in the laboratory testing performed on this patient.

A bone marrow aspirate and biopsy were performed. The BM was hypercellular with few blasts; promyelocytes were the predominant cell and many contained bundles of Auer rods. Megakaryocytes were absent. Cytochemical staining was completed on the BM sample with the results as follows:

       Myeloperoxidase     positive

       Sudan Black B              positive

       Chloroacetate esterase     positive

       Alpha-naphthyl butyrate esterase negative

       Periodic Acid Schiff       negative

  

   2. Does this patient’s test results suggest an acute or a chronic disorder? Justify your

   answer.

   3. Explain why cytochemical staining was ordered on this patient.

   4. For each cytochemical stain listed above:

       (a) state what specific cellular component (i.e., enzyme, glycogen, lipid) is

       reacting with the stain; and

       (b) identify which cell line(s) will react with the stain.

   5. Cytogenetic analysis was also ordered on this patient. A translocation of the long

   arms of chromosomes 15 and 17 was identified.

       (a) Briefly describe how cytogenetic analysis is performed.

       (b) Discuss the clinical use for cytogenetic analysis in hematology.

   6. Based on the physical exam results and all the laboratory data, what would the FAB

   and WHO classification (group and subgroup) be for this patient?

   7. Based on your answer to question #6:

       What result would you predict for each of the following cell markers using

       monoclonal antibodies?

       CD10, CD13, CD33, CD34, CD11b, CD14, Glycophorin A, HLA-DR

   8. Explain the likely cause for the coagulation results seen on this patient.

   9. What is the prognosis and likely therapeutic regimen for someone with

Answer 1

1. Myeloperoxidase positive indicates,

Myeloperoxidase enzyme in human encoded with MPO gene of chromosomes, it indicates the inflammation response of the body.

Sudan black B indicates acute lymphocytic leukemia.

chloroacetate esterase indicates Acute monocytic leukemia.

Alpha naphthyl butyrate acetate negative indicates cute myeloid leukemia.

periodic acid schiff Negative indicates no fungal infections.

2. Acute or chronic disorder:

Acute disorder.

Rational:

This cytochemical staining reports clearly reveals that acute disorder.

3. Why cytochemical stain ordered:

Cytochemical stain ordered to rule out newly diagnosed leukemia.

4. Myeloperixidase : enzyme: encoded with gene chromosomes.

Sudan black: Lipids: cell wall

Chloroacete estarase: enzyme : act on cell Netflix

Alpha napthyl buterate acetate: cytochemical

Periodic acid Schiff : glycoprotein: act on tissue