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Alinity hq

CHRONIC MYELOCYTIC LEUKEMIA

Description

This patient was diagnosed with chronic myelocytic leukemia (CML).

 

The peripheral blood showed extreme leukocytosis with absolute neutrophilia and high number of immature granulocytes (IG). The Left Shift morphological flag was triggered. In addition, there was slight normocytic anemia present with a minimally increased RDW. The manual differential confirmed the predominance of the neutrophil lineage, with a full spectrum of the various development stages: promyelocytes, myelocytes, metamyelocytes, band and mature neutrophil granulocytes, consistent with the Left Shift flag. The number of IG, seen on the smear, showed good agreement with the Alinity hq IG count.

 

Neutrophilic Left Shift (increase in the number of immature granulocyte forms in the peripheral blood) may be associated with infection, inflammation or malignancy, particularly myeloproliferative neoplasms such as CML, which can be confirmed through genetic testing and identification of BCR-ABL gene fusion t(9:22) (Elliott).

Numerical Results

 
WBC 100 10e3/μL
NEU 59.6 10e3/μL 59.6 % Left Shift
LYM 3.88 10e3/μL 3.88 %
MONO 9.61 10e3/μL 9.61 %
EOS 0.00 10e3/μL 0.00 %
BASO .173 10e3/μL .173 %
IG 26.8 10e3/μL 26.8 %
NRBC 0.00 10e3/μL
NR/W 0.00

 
RBC 3.72 10e6/μL
HGB 11.4 g/dL
HCT 35.3 %
MCV 90.3 fL
MCH 29.2 pg
MCHC 32.3 g/dL
RDW 16.9 %

 
RETIC 43.0 10e3/μL 1.16 %
IRF 0.35
MCHr 31.4 pg

 
PLT 320. 10e3/μL
MPV 7.81 fL
%rP 20.4 %

 
FIGURE 1. IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
The IAS vs. ALL scatterplot shows a predominant neutrophil population (yellow) with an increased spread along the x and y axis. These changes are detected by algorithm, triggering the Left Shift flag and the quantification of IG.
FIGURE 2. ALL x PSS (WBC):
Size vs. polarized side scatter plot
The neutrophil cluster (yellow) is wide along the x-axis, suggesting variable cell size. The neutrophil population is also shifted downward along the y-axis, indicating reduced degree of nuclear segmentation and granularity, due to the large number of immature cells.
TABLE 1 :
Manual Differential Results
Alinity hq casebook. Myelodysplastic Syndrome. ADD-00061876-v2 2019. p.42-43

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Alinity h-series is available in select countries, not including the US.