This patient had evident leukocytosis with a mild anemia and thrombocytopenia. In the SIZE/COMPLEXITY graph a notably disperse neutrophil cluster was seen, extending towards the upper central region of the plot. This corresponded to the presence of large-sized granular cells with characteristics (nuclear shape, nuclear/cytoplasmic ratio and granularity) that were different from normal mature neutrophils. These were immature granulocytes (myelocytes, metamyelocytes and non-segmented neutrophils). The suspected presence of immature precursors was indicated by the IG/Band flag. All four WBC scatterplots demonstrated large neutrophils, compatible with (meta) myelocytes that were seen in the smear. In the 90º/WBC 0º scatterplot there was a population of large mononuclear cells visible in the lower right corner (purple events). This population, classified as monocytes/blasts, corresponded well with the 4% blast counted by manual microscopy. Using molecular analysis, in this patient a diagnosis of chronic myeloid leukemia was made.
SUSPECT |
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WBC | 44.6 | 10e3/μL | ||
NEU | 40.47 | 90.59 | % | IG/BAND |
BLST | .120 | .269 | % |
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MONe | 2.09 | 4.69 | % |
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EOS | .215 | .482 | % |
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BASO | .233 | .522 | % |
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LYM | 1.526 | 3.419 | % | BLAST |
RBC | 3.63 | 10e6/μL |
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HGB | 10.6 | g/dL |
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HCT | 33.3 | % |
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MCV | 91.7 | fL |
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MCH | 29.1 | pg |
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MCHC | 31.7 | g/dL |
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RDW | 12.5 | % | ||
PLT | 71.3 | 10e3/μL |
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MPV | 9.69 | fL | ||