Acute Myelomonocytic Leukemia M4 EO, 2 patients
Quality Assurance
Program of
Hematology
Acute Myelomonocytic Leukemia with Eosinophilia (M4 Eo)
Criteria for a diagnosis of M4 AML:
Blasts more than 20% of bone marrow cells.
Bone marrow monocytic component (monoblasts
to monocytes) more than 20% of non-erythroid
cells and peripheral blood monocytic component
more than 5000/ฮผL, or
Bone marrow resembling M2 but peripheral
blood monocyte component more than 5000/ ฮผL
(Barbra Bain)
First Patient
54 years/Male
Clinical features:
Fatigability 2 weeks.
Rt upper cervical and inguinal L.N.
hepatosplenomegaly.
CBC & pbs
WBC: 112.4
Hb: 5.6
plt: 20.000
DLC:
N 2
E 3
L 5
blast 90
Microscopic examination of stained bone
marrow aspiration slides shows
hypercellular bone marrow particles . Bone
marrow is infiltrated with heterogeneous
population of blast cells, mostly with
abundant granulated cytoplasm . Blast cells
count 75% of bone marrow nucleated cells.
Marked eosinophilic precursors with
abnormal granulation (15-20% ANC).
Normal bone marrow hematopoietic
series are markedly reduced.
The eosinophil myelocytes
have prominent proeosinophilic granules
with basophilic staining characteristics.
Immunophenotyping performed on peripheral
blood revealed the presence of CD45+ blast
cells constituting 67% of ANC. They are positive
to myeloid and monocytic markers CD13, CD33,
CD14,CD15, CD 11c, CD34, CD117 and anti
HLA-DR, while negative for CD11b, CD41a, CD61,
CD 71, Anti Glycophorin A and most of lymphoid
markers CD10, CD2, CD3, CD4, CD5, CD7, CD8,
CD19, CD20, CD22, CD23 , CD56 and IgG.
Regarding cytoplasmic markers, they showed
positivity to myeloperoxidase and negative for
CD79a and TdT.
Second Patient:
41 years/Male
Pallor, and fatigability
CBC & pbs :
WBC: 21.27
Hb: 8
plt: 21.000
blast 33%
Monoblasts+promonocytes: 34%
Bone marrow aspiration shows
hypercellular bone marrow.
Erythropoietic series are markedly
reduced . Granulopoietic
series are predominant with 30%
monocytic precursors , 30%
Heterogeneous population of Blast
cells with occasional Auer rods and
20% Eosinophilic precursors
with abnormal cytoplasmic granulation.
Cytochemistry:
Myeloblasts and myeloid series
gives positive reaction with sudan
Black stain.
Monocytic precursors gives positive
reaction with Non specific esterase.
These two patients were seen
by Dr. Ali bin Saad Al Shamary ,
General Director of
Laboratories and Blood Banks,
and Dr. Mohammad Khair Ahmad
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