A laboratory professional is reviewing a peripheral blood smear ...

[abern]

A laboratory professional is reviewing a peripheral blood smear of a 10-year-old patient and notes that 35 blasts are present. Which of the following diagnoses is likely based on these findings?
 
  a. Myelodysplastic syndrome
  b. Acute leukemia
  c. Chronic myeloid leukemia
  d. Aplastic anemia

Question 2

A 61-year-old woman saw her primary care physician because of fatigue and dyspnea on exertion for the past 3 months.
 
  Past medical history noted that the patient had been treated 5 years earlier with the DNA alkylating agent cyclophosphamide, non-Hodgkin lymphoma.
 
  A CBC revealed the following:
  WBC: 3.6 x 109/L
  RBC: 2.8 x 1012/L
  Hb: 9.1 g/dL
  MCV: 104 fL
  Reticulocyte count: 2.0
  Normal vitamin B12 and folic acid levels
  PLT: 120 x 109/L
  Differential: 6 blasts
 
  A bone marrow biopsy revealed hypercellularity, and dyshematopoiesis of all three myeloid lineages.
  Suggest an appropriate follow-up test and a likely diagnosis for this patient.
 
  What will be an ideal response?

[meltdown117]

Answer to Question 1

Correct Answer: B

Answer to Question 2

Answer: Cytogenetics would be an appropriate follow-up test and would likely reveal a complex karyotype. The likely diagnosis is therapy-related myelodysplasia indicated because of the earlier treatment with cyclophosphamide and the trilineage cytopenias and dysplasia.

[abern]

Excellent

[amit]

Gracias!