PMC3719108_01
Peripheral blood leukocytes. A) peroxidase (POX) negative neutrophil; B) hypogranular neutrophil (May-Giemsa staining); C) neutrophil containing Auer body after initiation of ATRA treatment (May-Giemsa staining).
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Morphological examination detected frequent hypo-granular and peroxidase (POX)-negative neutrophils (Figure 1A and B). Because mature neutrophils with Auer rods were observed in peripheral blood (Figure 1C), the patient's leukemia was considered to be responsive to ATRA treatment.
Typical acute promyelocytic leukemia (APL) cells in bone marrow. A) and B) APL cells with hypergranular cytoplasm and Auer body or faggot cells (May-Giemsa staining); C) strongly positive staining for peroxidase.
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Iliac bone marrow aspiration produced a total nucleated cell count of 59x109/L and a megakaryocyte count of 25x106/L, while the differential count showed the bone marrow consisted of 28.2% myeloblasts and 55.2% abnormal promyelocytes, frequently containing Auer rods or faggot cells (Figure 2A and B). These cells were strongly positive for POX staining (Figure 2C).
Atypical cells in bone marrow smear (May-Giemsa staining). A) and B) micro megakaryocytes; C) megakryocyte with non-lobulated nucleus; D) megakaryocyte with isolated multi-nuclei; E) erythroblast showing karyorrhexis; F) erythroblast with a nucleus showing abnormal configuration.
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Micromegakaryocytes and megakryocytes with non-lobulated nuclei or isolated multi-nuclei (Figure 3A-D) as well as erythroblasts showing karyorrhexis or nuclei with abnormal configuration (Figure 3E and F) were also detected.