PMC4407518_01
B-Lymphoblastic leukemia. (a) Peripheral blood (Wright-Giemsa, 100x) showing a circulating large sized blast. (b) Bone marrow biopsy (hematoxylin & eosin, 50x) showing fibrotic marrow with small area of immature mononuclear cells. No areas of normal hematopoiesis were seen.
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fig1
After transfusion of a unit of platelets, his complete blood count showed a white blood cell count (WBC) of 7.1 K/mm3 (normal 4.5-11 K/mm3), hemoglobin 13.1 g/dL (normal 13.5-17.5 g/dL), platelets of 34 K/mm3, and a leukoerythroblastic peripheral blood smear showing 2% circulating blasts (Figure 1(a)). A subsequent bone marrow biopsy showed a hypercellular marrow (approximately 85% of total cellularity) with 95% of the cellularity involved by diffuse sheets of monotonous round to slightly irregular lymphoblasts (Figure 1(b)).
BCR-ABL1 qualitative RT-PCR amplification curves. Lightcycler amplification curves showing the cycle number of the crossing point (CP), the point where the reaction's fluorescence reaches the maximum of the second derivative of the amplification curve corresponding to the point where the acceleration of the fluorescence signal is at its maximum. The CP is 29 cycles for the positive control (purple), 35 cycles for the patient's peripheral blood specimen (grey), and no amplification for the negative control (no DNA) (green). Thus, the BCR-ABL1 fusion transcript was detected from the patient's peripheral blood.
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fig2
Molecular studies for the BCR-ABL1 mutation showed a low positive qualitative PCR result for the BCR-ABL1 fusion transcript (Figure 2).