Middle-aged man with fever, lymphadenopathy and splenomegaly found to have elevated leukocyte count with increased eosinophils, myeloblasts, metamyelocytes and myelocytes most concerning for chronic myeloid leukemia
Key idea: Ways to differentiate between chronic myeloid leukemia and a leukemoid reaction include leukocyte alkaline phosphatase (LAP) levels (elevated in leukemoid reaction and decreased in CML), looking for basophilia (present in CML) and looking at the types of neutrophil precursors present (metamyelocytes > myelocytes in leukemoid reaction and metamyelocytes < myelocytes in CML)
Note: Metamyelocytes are more mature than myelocytes
Key idea: Can often tell they type of leukemia based on patient demographics with ALL seen in patients 0-14, AML seen in patients 15-60, CLL seen in patients 60+ and CML seen in patients 40-59
merpaperpleNot that it matters for answering the question correctly in this case, but wouldn't it be AML since he has myeloblasts, vs CML which would have mature myeloid cells? Maybe a blast crisis from CML -> AML?+
merpaperpleForget that, I was mistaken. Just so no one is misled by my post (since you can't delete posts here), apparently you can have myeloblasts in CML, there are just fewer of them than in AML. From MedlinePlus: "In the chronic phase, the number of mature white blood cells is elevated, and myeloblasts account for less than 10 percent of blood cells. Signs and symptoms of the condition during this phase are typically mild or absent and worsen slowly. The chronic phase can last from months to years. In the accelerated phase, the number of myeloblasts is slightly higher, making up 10 to 29 percent of blood cells. The signs and symptoms continue to worsen. The accelerated phase usually lasts 4 to 6 months, although it is skipped in some affected individuals. In blast crisis, 30 percent or more of blood or bone marrow cells are myeloblasts." (https://medlineplus.gov/genetics/condition/chronic-myeloid-leukemia/)+1
Oh absolutely not. Primary myelofibrosis ALSO presents with splenomegaly, pancytopenia and immature myeloid cells in the periphery. WBC counts for CML are typically >50,000. WTF is this question?
charcot_bouchardWBC and Platelet in myelofibrosis is variable....Not always dec. i still dont know what was i thinking. should have picked the cml since the rainbow wbc panel that they described from that+
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