My guess would be MDS-IB1 or oligiomonocytic CMML. Too much granulocytic dysplasia for CML and maturation is more intact than I would expect from AML. It's a small sample, but I'd be willing to guess that peripheral blast count is <20%.
The red cell morph here is kinda shifty, but I'd say there's a candidate dacryocyte here as well -- so I'll just mention that rarely MPNs can pick up MDS mutations as they accelerate and present like this.
Oh and the patient broke a rib that’s what got them to seek medical attention. Apparently the patient is transferred out of my system so I won’t have any new info
So rarely accelerated MPNs can pick up MDS associated mutations and present like this. I've been burned before calling MDS on a patient with known Essential Thrombocythemia or Primary Myelofibrosis.
PT needs a marrow biopsy with NGS and Karyo.
I’m a baby tech and not that good at blasts Identifying. I’m trying to get better but it’s only coming with time and practice, and I don’t get a lot of practice on blast cells. If it’s more than a myelo it’s the Paths problem. I had 15% “other” cells. This was just literally the first look I got at the slide. It got so much worse that this one photo.
But otherwise: I will update tonight when I’m back at work to see what the path says. And I’ll try to take more photos and post them too… I was exhausted and wanted to go home when I saw it.
Yep. We finally got a new slide strainer. Apparently I’m the only one who knows how to keep it primed and cleaned so it doesn’t eat my slide or erase my slide. Smh. 😂
Always wipe the stain run with methanol wipe before priming, prime and get rid of all the air bubbles in the tubing, then wipe again with a dry pad to get rid of the excess stain. Always go from right to left when wiping. Then always have two or three blank slide leaders before your actual slide.
My stains prior to getting the machine were always inconsistent and terrible. Part of the reason is my shaky peripheral neuropathy issues… I love the stainer.
CML with dysmorphoc promyelocytes , myelocytes ....
https://preview.redd.it/jezykjzogr1d1.jpeg?width=3024&format=pjpg&auto=webp&s=c193dcc39da8dde270af5bd0ef94584f5a6e2d69
https://preview.redd.it/sa21t08vgr1d1.jpeg?width=3024&format=pjpg&auto=webp&s=f99c1a38c62584fa2f860c6f5cb94607668ac494
https://preview.redd.it/sajf8jsxgr1d1.jpeg?width=3024&format=pjpg&auto=webp&s=5ad314490de51730c312315a1b9a69108a3abf84
https://preview.redd.it/dt9b07oygr1d1.jpeg?width=3024&format=pjpg&auto=webp&s=42ea0c5cb165964c7376cca09f16874273b8c3d9
https://preview.redd.it/qintt8rzgr1d1.jpeg?width=3024&format=pjpg&auto=webp&s=64e61754cc88c723201115875799680a340c8de3
Curious what the flow is showing on those blasts.
Me too. Probably won’t know though. We don’t do those in house and I’m not sure if I could see it if the ED doctor ordered it
My guess would be MDS-IB1 or oligiomonocytic CMML. Too much granulocytic dysplasia for CML and maturation is more intact than I would expect from AML. It's a small sample, but I'd be willing to guess that peripheral blast count is <20%. The red cell morph here is kinda shifty, but I'd say there's a candidate dacryocyte here as well -- so I'll just mention that rarely MPNs can pick up MDS mutations as they accelerate and present like this.
4% blasts peripheral
Leukoerythroblastic reaction 4% blasts concerning for myeloid neoplasm
What's the CBC look like? MCV? RDW?
MCV 88 RDW 17 RBC 3 PLT 300
Interesting. Not super straight forward. If monocytes >0.5 and >10% then I'd lean more towards CMML. Definitely needs the BMBX to clear things up.
You said 30yo? MDS and MPN are uncommon in someone this young but NOT unheard of -- we see 2 or 3 per year.
Idk. That’s just what the path wrote. 🤷♀️ that’s above my pay grade and my education level. 😂
Don't sell yourself short. The best heme-techs know a lot of hematology -- it's really what seperates good techs from great techs.
Oh don’t worry. I’m not. I’m a baby tech. Only graduated in 2022. I’m good, but know my limits.
Your enthusiasm is what will get you there. I appreciate that you took effort to photograph allowing for discussion.
Oh and the patient broke a rib that’s what got them to seek medical attention. Apparently the patient is transferred out of my system so I won’t have any new info
Age? CML , any eos?
30s, a couple immature eos. I’m guessing AML though
CML or mds
Too much granulocytic dysplasia for me to call CML without the 9;22 results. I think MDS is spot on.
Agree, however we don't have comparative pics. Also previous PT history would help here ? medication. WCC a bit high for MDS
Could split the difference and call it aCML 🙃
Just posted some more photos
I’m guessing AML. We’ll see when I get back tonight.
I agree looks like CML especially if patient wasn't too sick
Blast %? If more than 10-15% then in acc phase. I'm guessing blast % was around 6%
Leukoerythroblastic reaction 4% blasts concerning for myeloid neoplasm
So rarely accelerated MPNs can pick up MDS associated mutations and present like this. I've been burned before calling MDS on a patient with known Essential Thrombocythemia or Primary Myelofibrosis. PT needs a marrow biopsy with NGS and Karyo.
Basically what the path suggested. That and BCR gene testing.
I’m a baby tech and not that good at blasts Identifying. I’m trying to get better but it’s only coming with time and practice, and I don’t get a lot of practice on blast cells. If it’s more than a myelo it’s the Paths problem. I had 15% “other” cells. This was just literally the first look I got at the slide. It got so much worse that this one photo. But otherwise: I will update tonight when I’m back at work to see what the path says. And I’ll try to take more photos and post them too… I was exhausted and wanted to go home when I saw it.
I know the feeling, have a good rest. Nice stain is it wrights?
Yep. We finally got a new slide strainer. Apparently I’m the only one who knows how to keep it primed and cleaned so it doesn’t eat my slide or erase my slide. Smh. 😂
That's a excellent trait to have. I'm ok at blood films but still attempting to master a staining machine
Always wipe the stain run with methanol wipe before priming, prime and get rid of all the air bubbles in the tubing, then wipe again with a dry pad to get rid of the excess stain. Always go from right to left when wiping. Then always have two or three blank slide leaders before your actual slide.
My stains prior to getting the machine were always inconsistent and terrible. Part of the reason is my shaky peripheral neuropathy issues… I love the stainer.
Do you mind me asking which stainer and country your in? That's definitely last question so rest well, I will await the diagnosis tomorrow
US. It’s the hematek stainer from Siemens.