Authors: Tiarra Price, DO and Bryan Rea, MD
Case Presentation
The patient is a man in his 80’s with a history of mild anemia of unknown etiology. A prior bone marrow biopsy was suboptimal; however, it was slightly hypercellular with negative cytogenetics, myeloma FISH, MDS panel, and flow cytometry. A few years later, he presented to the emergency room with shortness of breath and left sided chest pressure with exertion. He was found to have leukocytosis, anemia and thrombocytopenia, with 30% circulating blasts (figures 1 & 2).
A bone marrow biopsy was performed. Flow cytometry revealed an expanded myeloblast population accounting for 70-80% of events. The myeloblasts were positive for CD33, CD117, CD45, CD123 and CD64 (dim) and negative for CD34, CD14, CD15, CD16, CD36, CD19, and HLR-DR (mostly negative). The manual differential count performed on the marrow aspirate revealed 85% blasts (figure 3). An NPM1 stain performed on the core biopsy was positive (figure 4).
