Male age 63

FBC Results       

WBC 32.5* (10^3/mm3) Neutrophils 61.1%

RBC 3.55 (10^6/mm3) Lymphocytes 7.6 % 

HGB 10.6 (g/dL) Monocytes 

HCT 30.8 % Eosinophils 0.8%                 

MCV 86.8 (fL) Blasts 17.6%

MCH 30.0 (pg) Myelocytes 7.6% 

MCHC 34.5 (g/dL) Metamyelocytes 5.3%

PLT 88* (10^3/mm3) Erythroblasts 3 

Large Platelets 2

Clinical Details

Male age 63, Emergency Unit

Slide Information

Thrombocytopenia.

Leukocytosis.

Neutrophilia.

Monocytosis: Monocytes/promonocytes/monoblasts?

Search for acute leukemia.

Neutrophils sometimes degranulated.

Myelemia+erythroblastosis.

Promonocytes(++).

Presence of macroplatelets.

For the attention of the expert: AML (4/5)?

Slide Information continued

In the context of AML with a monocytic component, should promonocytes always be classified with (mono)blasts : WHO criteria.

Blastosis estimated in this case at 5 G/L (15% of leukocytes).

Expert comment:

Appearance compatible with (monoblastic)AML5

Monoblast or Promonocyte?

In the paper ‘Morphological evaluation of monocytes and their precursors‘ published 2009 in the journal Hematologica a guide to identify the monocyte subtypes was presented. The article separated monocyte into 4 types, Monoblast (the precursor cell), Promonocyte, Immature Monocyte and Monocyte. With the following characteristics:

Using the above table we can identify the following cells in the slide.

It is important to be able to differentiate between Promonocytes and immature/mature monocytes as in the WHO classification Promonocytes are included with Monoblasts.

WHO Classification of Acute Myelomonocytic and Acute Monocytic Leukaemia.

As some of you may already know, Quality Slide Program (QSP) is scheduled to be discontinued at the end of this year. Therefore, this month’s issue will be the final edition. Starting in October, we will introduce a new name for the newsletter and continue to provide educational content focused on cell morphology. We plan to incorporate feedback from our subscribers’ surveys into the content. We would like to express our heartfelt gratitude to all of you who have been loyal readers of the QSP Newsletter over the past four years. We remain committed to delivering valuable information in the future.

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