You are performing complete blood cell counts on an automated analyzer. One of t

Question

You are performing complete blood cell counts on an automated analyzer. One of the patient samples is "flagged," indicating a possible instrument error or abnormal cell population in the sample. Previous samples on this patient have been run without problems, although the patient previously had quite low white blood cell (WBC) counts- less than 100 neutrophils and less than 500 total WBC/mL. As per laboratory protocol you review the Wright- stained blood film. On your manual differential count, you find that the monocyte count is slightly increased. You note the presence of immature cells of the granulocyte series, including occasional promyelocytes and myeloblasts. In addition, Dohle bodies, increased granulocyte granulation and hypersegmented neutrophils are present. 1. What common clinical conditions can lead to the immature myloid cells seen in this smear? 2. What should you do to help you interpret this sample

Explanation / Answer

Immature myeloid cells are significantly seen in acute myeloid leukemia. The presence of Dohle bodies, increased  granulocyte and hyperpigmented neutrophils are seen in systemic infections, exposure to cytotoxic agents, burns, trauma.

In order to interpret this sample correctly one can make further investigations and other diagnostic procedures like bone marrow biopsy, spinal fluid analysis, flow cytometry, cytogenetics etc.

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