Question

Clinical Laboratory

Mr. Cage's physician continues attempting to determine what ails her patient. Of note in his recent history was an emergency room visit for a laceration 6 months ago, and a prolonged fever 4 months ago that required antibiotic treatment to clear. The results of Mr. Cage's WBC Diff are below: Relative Count Absolute Count Segmented Neutrophils 35% Eosinophils Basophils Monocytes 1% 0% 4% 59% 1.3 x 10'uL 0.07 x 10/ul 0.01 x 10/ul 0.15 x 10'ul 2.2 x 10'uL No abnormal morphology of WBCs is noted, however the hematologist also notes that bands are absent. Mr. Cage's physician also elects to prepare a smear, pictured below: bone marrow The hematologist reports that the BM is decidedly hypocellular, showing an approximate loss of 85-90% of normal cellularity The cells that remain are almost entirely erythroid precursors. Only the rare myeloid precursor or megakaryocyte was visible 1. How does Mr. Cage's WBC Differential differ from a normal findin 2. What are "band" cells and what is the significance of not seeing any on a smear? 3. What is the role of the megakaryocyte? 4. What type of anemia does Mr. Cage have? 5. What is the most likely cause of Mr. Cage's anemia?

Answer 1

1. Mr.Cage's WBC differential shows neutropenia (Decreased count of neutrophils in the WBC)

    normal neutrophil count is between 40% to 80% but in his sample it shows 35%.

2. Band cells are cells which participate in granulopoiesis (formation of granulocytes) and they are

    derived from metamyelocyte cells in the bone marrow and it leads to a mature granulocyte.

   * Absence of band cells in the smear indicate failure of bone marrow to produce adequate

   blood cells for the normal functioning of body.

3 .Role of megakaryocytes

                   * Megakaryocytes are known as the precursor cells of platelets and the platelets are

                      formed from the cytoplasm of megakaryocytes.

4. Mr.Cage have Aplastic anemia which occurs due to the inability of bone marrow to produce

     hematopoietic stem cells result in decreased level of red blood cells,white blood cells and

     platelets.

5. Bone marrow report of the hematologist shows his bone marrow is hypocellular and loss of

    80% to 90% of normal cellularity it shows Mr.Cage may have acute myeloid leukemia.

   *In acute myeloid leukemia patients only 20% of cellular bone marrow seen when doing bone

   marrow smear examination.