Sushma Belurkar

Correlation of morphologic and cytochemical diagnosis with flowcytometric analysis in acute leukemia

INTRODUCTION The classification of acute leukemias has revolutionized over the years. Immunophenotyping of acute leukemia has gained popularity because of its influence on treatment and prognosis of the disease. The various antigens expressed by the leukemic cells can be assessed by flowcytometry (FCA) and can be used in rendering specific treatment and predicting the outcome of the different types of acute leukemia. AIMS The main aim of this study was to compare the morphologic and cytochemical diagnoses with flowcytometric diagnoses in acute leukemia and to analyze the usefulness of FCA over morphology. RESULTS In this study we analyzed 50 cases of acute leukemia and found concordance rate as high as 86% between morphologic/cytochemical diagnosis and flowcytometric diagnosis. Of these, complete concordance was seen in 58% of the cases and partial concordance was seen in 22% of the cases. Non-concordance was seen in only 4% of our cases. In remaining 16% of our cases FCA helped in sub classifying the acute leukemia where morphology and cytochemistry had failed to do so. CD19 and 20 were found to be consistent B-cell markers and CD3 was a very specific marker for T-cell leukemia. CD13 and 33 were important myeloid markers and were aided by other secondary panel of markers like CD14, CD117 and CD41. CONCLUSION FCA not only helps in confirming morphologic diagnosis in acute leukemia but also helps in assigning specific lineage to the blasts, particularly in acute lymphoid leukemia. Immunophenotyping is of utmost importance in classifying acute leukemia as it greatly influences the treatment and the prognosis.

Chronic Myeloid Leukemia with Hyperdiploidy: A Case Report with Review of Literature

Chronic myeloid leukemia (CML) is a common marrow stem cell neoplasm characterized by the presence of the Philadelphia (Ph) chromosome in more than 90% of patients. Studies have shown that CML can be associated with various other cytogenetic abnormalities. 5-10% of these cases can show complex translocations involving other chromosomes in addition to Ph chromosome. Here, we report a Ph-positive CML patient with a hyperdiploid karyotype who presented clinically in chronic phase but progressed to blast crisis in spite of treatment with Imatinib. This case highlights the significance of cytogenetic abnormalities on the prognosis in CML.

Glanzmann's thrombasthenia: The clinicopathological spectrum and its diversities

Aim: To study the clinical spectrum of patients with Glanzmann′s Thrombasthenia (GT) in a tertiary care hospital in South India and to correlate the clinical & laboratory parameters of GT. Materials and Methods: This study includes 15 patients who were diagnosed as GT by characteristic clinical features, basic lab parameters (prolonged bleeding time, abnormal clot retraction and absence of platelet clumps on direct smear) and platelet aggregometry. Results: 66.6% of our patients were below 10 years of age. The common forms of bleeding in our patients was epistaxis,gum bleeding and prolonged bleeding from trauma site which was seen in >50% of our patients.The significant findings on routine laboratory testing was a prolonged bleeding time (93.33%) and an abnormal clot retraction test (66.6%). Platelet aggregation studies showed decreased aggregation with ADP, Collagen and Epinephrine in 100% of our patients whereas 50% also showed decreased aggregation with Ristocetin.Hence most of the patients in this study presented with the classical symptoms and laboratory findings of GT however some had unusual findings. Conclusion: The prevelance of GT is higher in southern India due to increased incidence of consanguineous marriages in this area.Though basic hemostatic screening tests and platelet aggregometry are sufficient to establish the diagnosis in majority of the patients,however some may require more sophisticated tests like flowcytometry for glycoprotein (GP) IIb-IIIa.

Blastoid variant of mantle cell lymphoma with leukemic presentation - A rare case report

Mantle Cell Lymphoma (MCL) is a type of Non-Hodgkins lymphoma and has a wide spectrum of histopathological subtypes of which the blastoid or the blastic variant constitutes 10-15% of all cases. It is difficult to diagnose blastoid variant of MCL on the basis of morphology alone as it mimics lymphoblastic lymphoma and centroblastic large cell lymphoma, hence additional analysis like immunophenotyping and molecular studies aid in its diagnosis. We present a case of 45-year-old male who presented to medicine OPD with chief complaints of fever, fatigability and inguinal swelling. Complete blood count, peripheral smear and bone marrow examination was performed. Peripheral smear showed thrombocytopenia along with 53% abnormal cells. On bone marrow examination 43% abnormal lymphoid cells were seen. This case was diagnosed as blastoid variant of MCL on the basis of routine morphology and immunohistochemistry on bone marrow biopsy and flow cytometric immunophenotyping on peripheral blood.