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Acute Lymphocytic Leukemia (ALL)


This young girl presented with an evident leukocytosis (82.0 x 10^9/L), primarily due to lymphocytosis (78.9 x 10^9/L). The leukocytosis was combined with anemia and thrombocytopenia. The graphical WBC essentially showed a single population cluster with moderate size variability, triggering the VAR LYM flag.


Although the predominant population was nominally classified as lymphoid, the total picture was highly indicative for high-grade malignancy such as lymphoblastic lymphoma or acute leukemia. Microscopic assessment of the smear revealed that practical all leukocytes were blasts. Immunological typing of the leukemic cells revealed them to be of the T-cell lineage.


Finally, the LRI flag indicated the presence of lower range interference in the platelet count. The LRI flag is relatively commonly seen in the condition where a low platelet concentration is accompanied by high-grade proliferations that have circulating cell fragments or abnormal plasma components.

Numerical Results

WBC 82.0 10e3/μL
NEU 2.61 3.18 %
BLST .056 .068 %
MONe .203 .248 %
EOS .084 .103 %
BASO .091 .111 %
LYM 78.95 96.3 % VARLYM

RBC 3.27 10e6/μL
HGB 9.12 g/dL
HCT 28.5 %
MCV 87.2 fL
MCH 27.9 pg
MCHC 32.0 g/dL
RDW 12.9 %

PLT 36.5* 10e3/μL
MPV 3.95* fL LRI

CELL-DYN Ruby Casebook. Acute Lymphocytic Leukemia (ALL). 2018. ADD-00005070. p.41
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