Question

#2

A 55‐year‐old male had known leukemia for 5 years duration.

He is being admitted today because of dyspnea, anorexia, malaise, and 2 weeks of a nonproductive cough. His physical examination reveals a temperature of 101°F, fluid in his lungs, labored respiration, and hepatomegaly.   

Lab results:   

Hgb = 7.3 g/dL  

Hct = 23%  

Plt count = 41 x 109/L

Smear = mostly myelocytic and monocytic cells BM analysis = 70% blasts  

Cytochemical stains:   

SBB = 98 blast cells +

Nonspecific esterase = 73 blast cells +

1. What is your presumptive clinical impression, given the cytochemical stain results?
  

a. Acute promyelocytic leukemia  

b. Acute lymphocytic leukemia  

c. Acute myelomonocytic leukemia  

d. Chronic leukemia  

2.Blasts in the bone marrow contained auer rods. This distinguishes them as which of
    the following?
  

a. Lymphoblasts  

b. Lymphoma cells  

c. Myeloblasts  

d. Monocytes   

3. Which CD markers are associated with monoblasts?

a. CD 19, 22  

b. CD 41, 61  

c. CD 33, 34  

d. CD 4, 14  

Answer 1

1. From the bone marrow analysis there is increased blast cells (70%) so it should be acute not chronic.

Now from the results of cytochemical stain:-

Sudan Black B positive for 98 blast cells= Myeloblast.

Non specific esterase positive for 73 blast cells= monocytes.

so the correct option is (c) Acute myelomonocytic leukemia.

2. Auer rods are red staining, needle shaped bodies seen when stain with myeloperoxidase (MPO) stain.

Only seen in Myeloid blast cells (characteristic feature).

Never seen in lymphoblasts, lymphoma and monocytes.

Correct option (c) Myeloblast.

3. CD marker Associated with

• CD 19, 22. B- lymphocytes
• CD 4, 14 T - lymphocytes
• CD 33, 34. Myeloblast
• CD 41, 61. Platelets

(c) CD 33, 34 is the correct option