AML M1 FAB: Acute myeloblastic leukaemia (immature) - case report 2

Author(s): S. Fruehauf, A. Pitkus
Last change: 2004/08/19

Sort of case report: In clinical view

Medical history: The patient presented to the Hematology Outpatient Clinic for investigation of an anemia. The initial results indicated the presence of an anemia of the classification Refractory Anemia with Excess Blasts type 1 (RAEB-1). Therapy was not indicated at this time. About 4 months later, the patient reported symptoms of tiredness, shivering, and a fever.

Clinical Examination: At this time complete blood count (CBC) with the results below indicate a leukocytosis of 20.09 /nl and 42% blasts circulating in the peripheral blood. A bone marrow was performed 2 days later.

Laboratory results:

Parameter	Value	Normal value [unit]
RBC	4.0	4.0-5.2 g/dl
Hemoglobin	9.6	12.-15. g/dl
Hematocrit	0.29	0.36-0.52 l/l
MCV	73	83-97 fl
Plt	84	150-440 /nl
WBC	20.09	4.0-10.0 /nl
Neutrophils	4.82	1.8-7.7 /nl
Lymphocytes	5.83	1.0-4.8 /nl
Monocytes	0.40	0.2-0.8 /nl
Eosinophils		0-0.5 /nl
Differential	Results
Band Neutrophils	3	3-10 %
Segmented Neutrophils	21	50-70 %
Lymphocytes	29	25-40 %
Atypical Lymphs		%
Monocytes	2	2-9 %
Eosinophils		2-4 %
Basophils	1	0-1 %
Metamyelocytes	1	%
Myelocytes	1	%
Promyelocytes		%
Blasts	42	%
Normoblasts		/ 100 L
Bone Marrow Differential
Red Cell Precursors	20	%
Plasma Cells	2	%
Myeloblasts	64	%
Promyelocytes	1	%
Myelocytes	1	%
Metamyelocytes	3	%
Band Neutrophils	3	%
Segmented Neutrophils	2	%
Eosinophils	15	%
Basophils	1	%
Lymphocytes	7	%

Cytogenetics: Cytogenetics testing performed on the bone marrow resulted in a hypodyploid female karyotype with a 5q deletion, monosomy of chromosomes X, 17 and 18, and two complex aberrant chromosomes. The 5q deletion is a typical aberration found in myelodysplastic sydrome and acute myeloid leukemia. These findings with the two complex aberrant chromosomes together are considered prognostically unfavorable.

Other molecular diagnostics: Molecular diagnostics testing resulted in inconspicuous findings without proof of a BCR-ABL fusion transcript.

Diagnosis: Acute Myeloid Leukemia of the M1 subtype