PMC5738709_01
Initial diagnosis of ALL. Microscopic image of a Giemsa-Wright stained peripheral blood smear at presentation. Magnification, x100. ALL, acute lymphoblastic leukemia.
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Within four days the patient's leukocytes rose to 30.8/nl, consisting of 91% mainly atypical lymphocytes consistent with leukemic blasts (Fig. 1).
Course of disease. Changes in leucocyte count (109/l), LDH (U/l) and rate of CD45 low (%MNC) leucocytes in the peripheral blood by flow cytometry. Timeline is presented as the days following presentation. LDH, lactate dehydrogenase; CD, cluster of differentiation; MNC, mononuclear cell.
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On an ambulatory visit two days later, enlarged cervical lymph nodes were noted and the complete blood count (CBC) indicated progressive leukocytosis (Fig. 2).
Flow cytometry analysis of peripheral blood at the time of initial ALL diagnosis. ALL, acute lymphoblastic leukemia; CD, cluster of differentiation; PE, phycoerythrin; FITC, fluorescein isothiocyanate; TdT, terminal deoxynucleotidyl transferase.
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CD45 low leukocytes that expressed CD10, CD19, HLA-DR, CD20, cytoplasmic CD79a and terminal deoxynucleotidyl transferase (Fig. 3). Chromosome analysis depicted a 46,XX karyotype in 7/17, and a 46,XX,del(5)(q13q22) karyotype in 10/17 metaphases.
Timeline of clinical events and therapeutic interventions, listed as the days following presentation. CR, complete remission.
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The full clinical course is summarized in Fig. 4.