Hi Flowers Help! In October last year we received a bone marrow aspirate from an 18 weeks pregnant lady for ?AML. Morphology on the bone marrow was performed in another lab, but within a few days we also received peripheral blood which had Hb 64g/L, wcc 13.2, neutrophils 2.5, band 0.1, lymphocytes 3.3, and the comment on the film was "a large population of abnormal and somewhat primitive monocytes and a small number of agranular frank blasts. Many neutrophils are agranular. There are occasional nucleated RBC. ? evolving leukaemia on a dysplastic background." Cytogenetics revealed no consistent anomalies, and no evidence of deletion or rearrangement of 11q23. On flow, there was a population of cells (about 58% of total CD45+ events) which had the FSC/SSC characteristics of monocytes and/or promyelocytes/myelocytes, and the 45/SSC characteristics of mature myeloid cells - 45 almost as bright as lymphocytes and a higher sidescatter than would be expected for monocytes. The majority of these cells were CD33+CD14weak+CD15+HLADr+ and CD13-. About half were also CD11b+, and about 1/4 CD34+. They were reported as consistent with an M4/M5 leukaemia. She was treated with a modified ICE protocol - without etoposide on account of the pregnancy. A month later there were 10% of cells with the scatter characteristics of monocytes, and were CD33+CD14+CD13+CD11b+HLADr+ and CD15- - in other words, monocytes. No CD34+ cells to be seen. The baby was delivered by caesarean section in February, and treatment was resumed 2 weeks later, with conventional consolidation protocol. Three weeks ago we received another bone marrow aspirate. This time the aspirate morphology was normal, but 47% of CD45+ events had scatter properties of mature myeloid cells. Approximately 40% of these were CD34+CD14+CD33+CD13+CD15+CD11b+HLADr+. 9% of the cells had scatter properties of monocytes, and approximately half of these were also CD34+. ie. total CD34+ cells 22%. CD34 was checked and was positive using Dako FITC (clone QBEnd 10, class II) and BD PE (clone 8G12 Anti-HPCA-2). We suggested a repeat aspirate, which we received last week. This time the corresponding 45/SSC population has the FSC/SSC characteristics of mature myeloid cells, and the immunophenotype CD34-CD14-CD33+CD13+CD15+CD11b+HLADr-; in other words, normal myeloid cells. What's happening??? beth Beth Rees Flow Cytometry Lab Pathology Dept Royal Hobart Hospital Hobart, Tasmania Australia ph. 03 6222 8913
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