B-precursor-ALL of common (c)-ALL subtype - case report 3

Author(s): S. Fruehauf, A. Pitkus, J. Dengler, S. Kraeker
Last change: 2003/04/10

Sort of case report: in clinical view

Medical history: The patient was on vacation in Thailand, when he developed pneumonia. During the diagnostic process, the presence of an acute leukemia and pancytopenia were noted. The patient began antibiotic therapy and returned to Germany where he presented to our instutition.

Clinical Examination: A bone marrow was ordered for further investigation of the suspected leukemia. Below are the complete blood count (CBC ) results that accompanied the bone marrow.

Laboratory results:

Parameter	Value	Normal value [unit]
RBC	2.8	4.3-6.1 /pl
Hemoglobin	8.9	13.-17. g/dl
Hematocrit	0.26	0.38-0.52 l/l
MCV	91	83-97 fl
Plt	72	150-440 /nl
WBC	9.10	4.0-10.0 /nl
Neutrophils	0.27	1.8-7.7 /nl
Lymphocytes	5.28	1.0-4.8 /nl
Monocytes		0.2-0.8 /nl
Eosinophils		0-0.5 /nl
Differential	Results
Band Neutrophils		3-10 %
Segmented Neutrophils	3	50-70 %
Lymphocytes	58	25-10 %
Atypical Lymphs		0 %
Monocytes		2-9 %
Eosinophils		2-4 %
Basophils	1	0-1 %
Metamyelocytes		0 %
Myelocytes		0 %
Promyelocytes		0 %
Blasts	38	0 %
Normoblasts	1	/ 100 L

Cytogenetics: Cytogenetics testing was performed on a bone marrow specimen. 25 mitoses were analyzed. For 8 of the mitoses, a numerically normal male karyotype was shown. For 17 metaphases that were analyzed, a clone with a normal male karyotype was shown. In addition this karyotype had a t(9:22) translocation and Philadelphia Chromosome positivity.

Molecular genetics (incl. Southern blot, PCR): The Bcr Abl transcript e1a2 is with good sensitivity detected in the marrow with a Bcr Abl/GAPHD Ratio of 3,23 x 10-3.

Diagnosis: Acute pre B-cell lymphoblastic leukemia of the subtype c-ALL