Abstract Background The National Institute of Neoplastic Diseases (INEN) is a national reference center for specialized care in the diagnosis and treatment of Cancer, with above 5000 new cases per year. Between 2012 - 2017, Acute Promyelocytic Leukemia (APL) accounted for 22% of reported cases, with an incidence of 153 cases. APL is a subtype of myeloid leukemia characterized by a predominance of abnormal promyelocytes. The entity possesses unique morphologic, cytogenetic, and molecular features, including severe coagulopathy with a high risk of mortality. This case report presents an APL hypogranular variant using results from the Mindray BC-6800Plus hematological analyzer. Accurate and timely detection of these cases enables immediate attention, which will improve the patient*s quality of life. Methods A 20-year-old female patient was referred with a 2-week illness characterized by headache, persistent fever, general malaise, epistaxis, gingivorrhage and ecchymosis of the lower limbs. A whole blood sample was obtained in EDTA K2 vial. Complete CBC was analyzed in the hematological analyzer Mindray BC-6800Plus. Cell population data (CPD) was also reported as 3D scattergrams. Finally, blood smear was prepared for manual review. Results CBC report showed red blood cell count: 2.83 1012/l; hemoglobin: 80 g/l; hematocrit: 23.5%; MCV 83.0 fl; MCH 28.1 pg; MCHC 340 g/l; RDW-CV 13.8%; RDW-SD 42.9 fl; platelets 50 109/l; PWV 9. 6 fl; WBC: 53.62 109/l; lymphocytes 7.1%; monocytes 0.2%; eosinophils 0.7%; basophils 0.1%; neutrophils 82.7%; reticulocytes 0.14%; NRBC 0.00/100 leukocytes; HFC (high fluorescence cells) 0.1%; HFC 0.04 109/l; IMG (immature granulocyte) 9.2%. Reported alarms included abnormal scattergram; abnormal Lymphocytes/Blasts; immature granulocytes; left shift, leukocytosis, anemia and thrombocytopenia. The leukocyte scattergram showed a dense population with low to high fluorescence and variable internal complexity located along monocyte and neutrophil areas. The peripheral blood smear review confirmed abnormal promyelocytes with morphologic features associated with the hypogranular variant. Conclusion Mindray hematology analyzer offers and enables the analysis of cell population data (CPD). The laboratory should utilize graphic and CPD information provided by the analyzers together with the blood smear; in this case of APL hypogranular variant, which is rare and because symptoms are insidious in early stages, CPD analysis is promising in distinguishing APL from other hematological neoplasms, which significantly contributes to the early diagnosis of the disease. Early diagnosis is critical to anticipate complications associated with coagulation disorders, and to initiate treatment with ATRA, which shows an 80% remission in treated patients. The prognosis of APL is favorable due to immediate recognition and treatment.
Taboada et al. (Wed,) studied this question.