Saito Rie, Yokoyama Hisayuki, Meguro Kuniaki, Ohba Yusuke, Izumi Yoshihiko, Takahashi Shinichiro
Department of Clinical Laboratory, Tohoku Medical and Pharmaceutical University Hospital, Japan.
Department of Hematology, National Hospital Organization Sendai Medical Center, Japan.
Pract Lab Med. 2018 May 12;12:e00101. doi: 10.1016/j.plabm.2018.e00101. eCollection 2018 Nov.
A 38-year-old woman was suffering from back, right arm, and ankle joint pain, and visited our emergency department. Upon admission, the white blood cell (WBC) count was high (11,700/µL), and low numbers of red blood cells (2.21 × 10/µL) and platelets (PLTs) (42,000/µL) were observed. A PLT histogram showed an abnormally shaped peak at around 20-30 fL, suggesting the presence of giant PLTs or PLT aggregation. The WBC histogram showed abnormal elevation at 35 fL and around 100 fL, suggesting abnormal cells including nucleated red blood cells. A peripheral blood smear was prepared, and morphology was examined. As a result, blasts (4%) including many orthochromatic erythroblasts (48/100 WBCs) were observed. Acute leukemia was suspected, and the patient was transferred the next day to a hospital with a hematology department. Bone marrow aspiration revealed that 99% of cells were blasts positive for B lymphoid lineage markers and myeloperoxidase. The patient was diagnosed with mixed phenotype lineage acute leukemia, treated immediately, and achieved remission. Thus, careful observation of histogram abnormalities of an automatic blood cell analyzer is important for rapid diagnosis of acute leukemia.
一名38岁女性因背部、右臂和踝关节疼痛前来我院急诊科就诊。入院时，白细胞（WBC）计数较高（11,700/µL），红细胞（RBC）数量较低（2.21×10/µL），血小板（PLT）数量较低（42,000/µL）。血小板直方图显示在20 - 30 fL左右有异常形状的峰值，提示存在巨大血小板或血小板聚集。白细胞直方图显示在35 fL和100 fL左右有异常升高，提示存在包括有核红细胞在内的异常细胞。制备了外周血涂片并检查形态。结果，观察到包括许多正染红细胞（48/100个白细胞）在内的原始细胞（4%）。怀疑为急性白血病，患者于次日被转至设有血液科的医院。骨髓穿刺显示99%的细胞为B淋巴细胞系标志物和髓过氧化物酶阳性的原始细胞。该患者被诊断为混合表型急性白血病，立即接受治疗并实现缓解。因此，仔细观察自动血细胞分析仪的直方图异常情况对于急性白血病的快速诊断很重要。
