Hemacases Vol 1

HemaCase
Clinical Case Booklet

By using Mindray Fully Automated Cellular Analysis Lines
Volume 1
Preface
We are delighted to present you with this clinical case booklet on hematology.
At Mindray, our mission has always been to bring cutting-edge technology
within reach, ensuring that high-quality healthcare is available to all. As part of
this commitment, we have dedicated ourselves to enhancing the accuracy and
efficiency of hematology tests in clinical laboratories.
Through the pages of this booklet, we aim to provide you with real clinical
cases that vividly illustrate the seamless integration of information from blood
analyzers, morphological analysis, and clinical diagnostic data. With the
assistance of our state-of-the-art Automated Digital Cell Morphology Analyzer
MC-80, these cases showcase how early disease identification and diagnosis
can be achieved.
Our ultimate aspiration is for these cases to empower laboratory personnel, like
yourself, to gain invaluable insights in their daily work. By immersing yourself in
these scenarios, we hope you will not only expand your knowledge but also
elevate the quality of patient care you provide.
Contents
List of Abbreviations · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 04
Scattergrams of 5-part differential hematology analyzer · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 04
Case 01 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 05
Acute myeloblastic leukemia without maturation (M1)
Case 02 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 11
Acute promelocytic leukemia (APL)
Case 03 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 15
Acute myeloblastic leukemia with maturation (M2)
Case 04 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 17
Acute myelomonocytic leukemia (AMML)
Case 05 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 19
Thrombotic thrombocytopenic purpura (TTP)
Case 06 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 21
Chronic myelomonocytic leukemia (CMML)
Case 07 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 23
MDS with single lineage dysplasia (MDS-SLD)
Case 08 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 25
MDS with excess blasts (MDS-EB)
Case 09 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 27
Multiple myeloma (MM)
Case 10 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 29
B-cell lymphoblastic leukemia/lymphoma (B-ALL)
Case 11 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 31
B-cell lymphoblastic leukemia/lymphoma (B-ALL)
Case 12 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 33
Chronic Lymophocytic leukemia (CLL)
Case 13 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 35
Mantle cell lymphoma (MCL)
Case 14 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 37
May-Hegglin anomaly
Case 15 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 39
Pelger–Huët
Case 16 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 42
Green neutrophilic inclusion
References · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 45
03 | HemaCase—Clinical Case Booklet

List of Abbreviations
WBC White blood cell Eos Eosinophil RET# Reticulocyte count
Neu Neutrophil Eos# Eosinophil count RET% Reticulocyte percentage

Reticulocyte hemoglobin
Neu# Neutrophil count Eos% Eosinophil percentage RHE expression
Neu% Neutrophil percentage Bas Basophil IRF Immature reticulocyte fraction
Lym Lymphocyte Bas# Basophil count PLT Platelet
Lym# Lymphocyte count Bas% Basophil percentage PLT-I Platelet counting with impedance
method
Lym% Lymphocyte percentage RBC Red blood cell PLT-O Platelet counting with optical
method
Mon Monocyte HGB Hemoglobin IPF Immature platelet fraction
Mon# Monocyte count MCV Mean corpuscular volume
Mon% Monocyte percentage NRBC Nucleated RBCs
Scattergrams of 5-part differential hematology analyzer
TM
DIFF Scattergram
1 Abnormal lymphocytes 5 Neutrophils and basophils

2 Immature granulocytes 6 Eosinophils
3 Monocytes 7 Ghost
4 Lymphocytes
WNB Scattergram RET Scattergram
1 Nucleated RBCs 1 Mature red blood cells

2 Basophils 2 Low-fluorescence
reticulocytes
3 White blood cells
3 Medium-fluorescence
4 Ghost
reticulocytes
4 High-fluorescence
reticulocytes
5 Optical platelets
All morphological images in this case study book, unless otherwise noted,
are stained with Wright-Giemsa solution
HemaCase—Clinical Case Booklet | 04

Case 01
Acute myeloblastic leukemia without maturation (M1)
Clinical information
01
One year ago, the patient presented with a history of recurrent dry coughing for over six months, with worsening symptoms in
the last month. A chest CT scan revealed a nodule in the right middle lung, and further testing below confirmed a diagnosis of
AML-M1.
Item Parameter Result

WBC 195.4*10^9/L After more than 4 months of
CBC HGB 92g/L chemotherapy, the patient improved
PLT 11*10^9/L and was discharged. However, the
Bone marrow Bone marrow Highly active bone marrow with 95% of myeloblasts, indicating patient relapsed 2 months later and
morphology morphology acute myeloid leukemia of the AML-M1 subtype.
underwent 6 months of continued
Immunophenotyping Immunophenotyping Immunophenotyping suggested AML chemotherapy. Bone mzarrow
Chromosome Chromosome 46，XX[20]
morphology suggested that the
FLT3-ITD mutation AR=0.271
disease was not resolved, so the
Bone marrow CEBPA p.Thr310dup 45.6%
NGS
patient was readmitted for treatment
CEBPA p.Gln83fs 47.1%
on Jun. 2.
WT1 p.Gly356Ter 44.7%
CBC results
CBC results on Jun. 1

Parameter Alarm Result Unit
RBC PLT DIFF
WBC & L 0.85 10^9/L
Neu# & R L 0.26 10^9/L
FL
Lym# & R L 0.57 10^9/L
Mon# R L 0.02 10^9/L
Eos# L 0.00 10^9/L
Bas# 0.00 10^9/L
IMG# R 0.00 10^9/L
Neu% & R L 30.6 % 0 10 20
0 100 200 fL 0 10 20 30 fL
Lym% & R H 66.0 %
SS
Mon% R L 2.5 %
Eos% 0.6 %
Bas% 0.3 % WNB Alarm
IMG% R 0.5 %
FS
RBC L 2.01 10^12/L
HGB L 75 g/L - Pancytopenia
HCT L 22.8 % - Blasts?
MCV H 113.3 fL - Abn Lymph/blast?
MCH H 37.0 pg ……
MCHC 327 g/L
RDW-CV H 22.3 %
RDW-SD H 90.3 fL FL
PLT R L 4 10^9/L
MPV **** fL
WBC decreased with inverted Neu% and Lym%; decreased RBC and HGB;
PDW ****
extremely low PLT count.
PCT **** %
P-LCC **** 10^9/L NRBCs were visible in the WNB channel; due to the decreased WBC, the DIFF 3X
P-LCR **** % channel was used to increase the particle count by 3 times, thereby improving the
NRBC# 0.130 10^9/L
repeatability of classification results and the ability to detect abnormal cells. The
NRBC% 15.28 /100WBC
scattergram showed that Mon particles extended upward into the abnormal
lymphocytes/blasts region. The instrument also gave an alarm.
Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
Pre-classification
Pre-classification
by the
byreader
the reader
on Jun.
on Jun.
1 1
White blood
White cells
blood cells
White blood
Whitecells
blood cells 100 100 100% 100%
Blasts
Blasts
L Segmented
L Segmented neutrophils 18
neutrophils 18 18.0 18.0
Band neutrophils
Band neutrophils 4 4 4.0 4.0
H Lymphocytes
H Lymphocytes 70 70 70.0 70.0
Eosinophils
Eosinophils 1 1 1.0 1.0
! Blasts
! Blasts 7 7 7.0 7.0
Non-white
Non-white
blood cells
blood cells 45 45 % %
! Nucleated
! Nucleated
RBCs RBCs 12 12 12.0 12.0
Large platelets
Large platelets 1 1
SmudgeSmudge
cells cells 9 9 9.0 9.0
PlateletPlatelet
Estimation
Estimation
PLT estimate
PLT estimate Estimated
Estimated
result result methodmethod
Platelet Platelet
concentration
concentration 6*10^9/L6*10^9/L Automated
Automated
Platelet Platelet
concentration
concentration 9*10^9/L9*10^9/L Manual Manual
Red blood
Red cells
blood cells
Size Size Degree Degree % %
! Anisocytosis
! Anisocytosis 3+ 3+
Macrocytes
Macrocytes 0 0 6.7 6.7
Microcytes
Microcytes 0 0 5.3 5.3
Color Color Degree Degree % %
! Hypochromic
! Hypochromic
cells cells 2+ 2+ 15.0 15.0
Polychromasia
Polychromasia 0 0 0.8 0.8 Results
Results
fromfrom
manual
manual
re-classification
re-classification
Shape Shape Degree Degree % %
! Poikilocytosis
! Poikilocytosis 3+ 3+ Segmented
Segmented
neutrophils
neutrophils
accounted
accounted
for 16%,
forband
16%, neutrophils
band neutrophils
! Schistocytes
! Schistocytes 1+ 1+ 0.6 0.6 accounted
accounted
for 3%,formetamyelocytes
3%, metamyelocytes
accounted
accounted
for 3%,for 3%,
Echinocytes
Echinocytes 0 0 0.0 0.0 lymphocytes
lymphocytes
accounted
accounted
for 70%,
forand
70%,myeloblasts
and myeloblasts
accounted
accounted
Elliptocytes
Elliptocytes 0 0 0.9 0.9 for 7%.for
The
7%.blasts
The blasts
had small
had round
small round
cell bodies
cell bodies
and large,
and large,
! ! Ovalocytes
Ovalocytes 3+ 3+ 21.9 21.9 roundround
or ovalornuclei
oval nuclei
with fine
withchromatins.
fine chromatins.
SomeSome
blasts blasts
had had
Stomatocytes
Stomatocytes 0 0 1.6 1.6
visiblevisible
nucleoli
nucleoli
and scant
and scant
cytoplasm
cytoplasm
that appeared
that appeared
pale blue.
pale blue.
Target cells
Target cells 0 0 0.2 0.2
The PLTTheestimate
PLT estimate
was consistent
was consistent
with the
with
CBC
theresult.
CBC result.
Teardrop
Teardrop
CaseCase
analysis
analysis
At theAtinitial
the initial
diagnosis,
diagnosis,
the patient
the patient
had a had
bonea bone
marrow marrow
blast percentage
blast percentage
of 95%ofand
95%was
anddiagnosed
was diagnosedwith Acute
with Acute
myeloblastic
myeloblastic
leukemia
leukemia
(AML-M1).
(AML-M1).
There There
were nowere
chromosomal
no chromosomal
abnormalities,
abnormalities,
but CEBPA
but CEBPA
mutation
mutation
was present.
was present.
Generally,
Generally,
AML patients
AML patients
with with
biallelic
biallelic
CEBPACEBPA
mutation mutation
have ahave
good a good
prognosis,
prognosis,
but inbutthisincase,
this the
case,
patient
the patient
also had
alsoanhad
FLT3-ITD
an FLT3-ITD
(FMS-like
(FMS-like
tyrosine
tyrosine
kinasekinase
3-internal
3-internal
tandem tandem
duplication)
duplication)
mutation,
mutation,
whichwhich
is a strong
is a strong
indicator
indicator
of poorof prognosis
poor prognosis
as it leads
as it to
leads
increased
to increased
tyrosine
tyrosine
kinasekinase
activity
activity
and theandactivation
the activation
of various
of various
tumors,
tumors,
especially
especially
AML. Therefore,
AML. Therefore,
the patient
the patient
relapsed
relapsed
after only
aftertwo
onlymonths
two months
following
following
improvement
improvementwith treatment,
with treatment,
and subsequent
and subsequent
treatment
treatment
resultsresults
were not
wereideal.
not ideal.
The DIFF
Thescattergram
DIFF scattergram
of theofCBC
theshowed
CBC showed
that the
that
upper
the upper
part ofpart
theof
Lym
thecluster
Lym cluster
was pointed
was pointed
and slightly
and slightly
extendedextended
to theto the
upperupper
right; although
right; although
the Montheparticles
Mon particles
were scarce,
were scarce,
they were
they significantly
were significantly
elevated,
elevated,
some some
of which
of which
enteredentered
the abnormal
the abnormal
lymphocytes/myeloblast
lymphocytes/myeloblast region,region,
and was
andshifted
was shifted
to thetoright
theoverall,
right overall,
indicating
indicating
the possible
the possible
presence
presence
of abnormal
of abnormal
cells. This
cells. This
corresponds
corresponds
to thetoresults
the results
of theofperipheral
the peripheral
bloodblood
smearsmear
reading.
reading.
Blasts Blasts
were observed
were observed
in 7% in
of 7%
peripheral
of peripheral
bloodblood
cells. cells.
Compared
Compared
with typical
with typical
myeloblasts
myeloblasts
(as shown
(as shown
in thein
figure
the figure
below),
below),
blasts blasts
have scant
have scant
cytoplasm
cytoplasm
and less
andfine
lessand
fineloose
and loose
chromatins,
chromatins,
whichwhich
to someto some
extentextent
affected
affected
the binding
the binding
of nucleic
of nucleic
acid fluorescent
acid fluorescent
dyes, resulting
dyes, resulting
in relatively
in relatively
weak FL weak
signals
FL signals
of of
the corresponding
the corresponding
particles
particles
in thein
DIFF
thescattergram.
DIFF scattergram.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 06 |
Case Booklet 06
Case analysis
Reference figures
of blasts
After the patient was admitted to the hospital, the chemotherapy regimen was changed. We tracked the CBC and peripheral
blood morphology results as follows:
The CBC results from Jul. 6, Jul. 13, and Aug. 3 are shown from right to left
Parameter Alarm Result Delta# 07-13 07-6 Unit RBC RBC RBC
WBC & L 2.35 0.040 2.31 1.96 10^9/L
Neu# & R L 0.62 -0.200 0.82 0.55 10^9/L
Lym# & R 1.70 0.310 1.39 1.35 10^9/L
Mon# R L 0.02 -0.010 0.03 0.03 10^9/L
Eos# R L 0.01 -0.060 0.07 0.03 10^9/L
Bas# R 0.00 0.000 0.00 0.00 10^9/L
IMG# R 0.08 -0.050 0.13 0.08 10^9/L 0 100 200 fL 0 100 200 fL 0 100 200 fL
Neu% & R L 26.2 -9.40 35.6 28.2 %

Lym% & R H 72.2 12.40 59.8 68.8 %
Mon% R L 1.0 -0.40 1.4 1.3 % PLT PLT PLT
Eos% R 0.5 -2.50 3.0 1.6 %
Bas% R 0.1 -0.10 0.2 0.1 %
20 20
IMG% R 3.2 -2.50 5.7 4.2 %
RBC L 2.83 0.350 2.48 2.05 10^12/L
HGB L 96 7.0 89 76 g/L
HCT L 30.9 2.40 28.5 24.1 %
0 10 20 30 fL 0 10 20 30 fL 0 10 20 30 fL
MCV H 109.4 -5.50 114.9 117.4 fL
MCH H 34.1 -1.70 35.8 36.9 pg
MCHC L 312 1.0 311 315 g/L WNB WNB WNB
RDW-CV 14.9 -2.70 17.6 19.1 %
FS FS FS
RDW-SD H 63.5 -15.00 78.5 81.2 fL
PLT & L 13 4.0 9 18 10^9/L
MPV R 10.6 -1.00 11.6 15.2 fL
PDW R 16.3 0.10 16.2 17.8
PCT R L 0.008 -0.0010 0.009 0.027 %
P-LCC R L 6 2.0 4 11 10^9/L FL FL FL
P-LCR R 44.8 -2.00 46.8 61.3 %

IPF H 26.9 -1.10 28.0 % DIFF DIFF DIFF
RET# 0.1974 -0.1371 0.3345 10^12/L
FL FL fLFL
RET% H 6.98 -6.500 13.48 %
IRF 24.4 -15.70 59.9 %
LFR L 75.6 15.70 59.9 %
MFR 19.8 -9.70 29.5 %
HFR 4.6 -6.00 10.6 %
SS SS SS
RHE 34.6 0.00 34.6 pg
FL
The results from the three tests were similar. Compared with the results before admission, there was an increase in WBC and
HGB. The DIFF scattergram showed that Lym particles further shifted towards the upper right corner, with an increase in the
density of particles in the upper region, suggesting that abnormal cells still existed and their percentage might be increasing.

Peripheral
Peripheral
blood
blood
morphology
morphology
results
results
fromfrom
Jul. 6Jul.
to Aug.
6 to Aug.
3 3
AnalysisAnalysis
time 09:07,
time Jul.
09:07,
6, 2022
Jul. 6, 2022 AnalysisAnalysis
time 08:14,
time Jul.
08:14,
13, Jul.
2022 13, 2022 AnalysisAnalysis
time 08:51,
time Aug.
08:51,
8, Aug.
20228, 2022
White blood
White cells
blood cells White blood
White cells
blood cells White blood
White cells
blood cells
White blood
Whitecells
blood cells 302 302
100% 100% White blood
Whitecells
blood cells 301 301
100% 100% White blood
Whitecells
blood cells 300 300
100% 100%
L Segmented
neutrophils 4815.9 15.9 L Segmented
neutrophils 58
19.3 19.3 L Segmented
neutrophils 50
16.7 16.7
Band neutrophils
Band neutrophils 20 206.6 6.6 Band neutrophils
Band neutrophils 20 20
6.6 6.6 Band neutrophils
Band neutrophils 15 15
5.0 5.0
Lymphocytes
Lymphocytes 97 9732.1 32.1 Lymphocytes
Lymphocytes 90 90
29.9 29.9 H Lymphocytes
H Lymphocytes 133 133
44.4 44.4
L Monocytes
L Monocytes 3 3 1.0 1.0 L Monocytes
L Monocytes 3 31.0 1.0 L Monocytes
L Monocytes 4 41.3 1.3
Eosinophils
Eosinophils 4 4 1.3 1.3 Eosinophils
Eosinophils 11 11
3.7 3.7 ! ! Myelocytes
Myelocytes 10 10
3.3 3.3
Metamyelocytes
Metamyelocytes 1 1 0.3 0.3 Metamyelocytes
Metamyelocytes 3 31.0 1.0 ! Promyelocytes
! Promyelocytes 4 41.3 1.3
! ! Myelocytes
Myelocytes 17 175.6 5.6 ! ! Myelocyte
Myelocyte 15 15
5.0 5.0 ! Blasts! Blasts 83 83
27.7 27.7
! Blasts ! Blasts 112 112

37.2 37.2 Promyelocytes
Promyelocytes 1 10.3 0.3 Reactive Reactive
lymphocytes
lymphocytes 1 10.3 0.3
Non-white
Non-white
blood cells
blood cells116 116
% % ! Blasts! Blasts 99 99
32.9 32.9 Non-white
Non-white
blood cells
blood cells65 65
% %
! ! Nucleated
Nucleated RBCs RBCs 93 9330.8 30.8
Reactive Reactive
lymphocytes
lymphocytes 1 10.3 0.3 ! Nucleated
! Nucleated
RBCs RBCs 33 33
11.0 11.0
Giant platelets
Giant platelets 1 1
Non-white
Non-white blood cells116
blood cells 116
% % Giant platelets
Giant platelets 1 1
! Nucleated
! Nucleated
RBCs RBCs 66 66
21.9 21.9 Large platelets
Large platelets 10 10
Large platelets
Large platelets 3 3
Large platelets
Large platelets 2 2 SmudgeSmudge
cells cells 11 11
3.7 3.7
Smudge Smudge
cells cells 14 144.6 4.6
Smudge Smudge
cells cells 14 14
4.7 4.7
Blasts Blasts
Three Three
peripheral
peripheral
bloodblood
morphology
morphology
resultsresults
were consistent
were consistent
with the
withCBC
theresults.
CBC results.
Myeloblasts
Myeloblasts
and immature
and immaturegranulocytes
granulocytes
at all at all
stagesstages
of development
of development
were visible.
were visible.
Due toDuereasons
to reasons
including
including
drug-induced
drug-induced
cell differentiation,
cell differentiation,
myeloblast
myeloblast
morphology
morphology
was was
atypical,
atypical,
with small
with cell
smallbodies
cell bodies
and less
andfine
lessand
fineloose
and loose
chromatins,
chromatins,
but nucleoli
but nucleoli
and Auer
andbodies
Auer bodies
were still
were visible.
still visible.
Despite
Despite
almostalmost
3 months
3 months
of treatment,
of treatment,
the patient's
the patient's
condition
condition
furtherfurther
deteriorated.
deteriorated.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 08 |
Case Booklet 08
CBC results on Aug. 24
Parameter Alarm Result Delta# 08-03 07-13 Unit
RBC PLT
WBC & H 201.32 198.970 2.35 2.31 10^9/L
Neu# **** 0.62 0.82 10^9/L
Lym# **** 1.70 1.39 10^9/L
Mon# **** 0.02 0.03 10^9/L
Eos# R 0.30 0.290 0.01 0.07 10^9/L
Bas# R 0.02 0.020 0.00 0.00 10^9/L
IMG# **** 0.08 0.13 10^9/L 0 100 200 fL 0 10 20 30 fL
Neu% **** 26.2 35.6 %
Lym% **** 72.2 59.8 %
Mon% **** 1.0 1.4 %
Eos% R L 0.1 -0.40 0.5 3.0 %
DIFF WNB
Bas% R 0.0 -0.10 0.1 0.2 % FL FS
IMG% **** 3.2 5.7 %
RBC L 2.66 -0.170 2.83 2.48 10^12/L
HGB L 85 -11.0 96 89 g/L
HCT L 28.6 -2.30 30.9 28.5 %
MCV H 107.4 -2.00 109.4 114.9 fL
MCH 31.8 -2.30 34.1 35.8 pg
SS FL
MCHC L 296 -16.0 312 311 g/L
RDW-CV H 16.4 1.50 14.9 17.6 %
RDW-SD H 68.4 4.90 63.5 78.5 fL Alarm
PLT L 20 7.0 13 9 10^9/L
MPV 9.0 -1.60 10.6 11.6 fL - Abn. WBC scattergram
PDW H 17.1 0.80 16.3 16.2 - Blasts?
PCT L 0.018 0.0100 0.0008 0.0009 % - Abn Lymph/blast?
P-LCC L 6 0.0 6 4 10^9/L - Immature Gran?
P-LCR 27.3 -17.50 44.8 46.8 ……
NRBC# 3.208 2.9740 0.234 0.632 10^9/L
NRBC% 1.59 -8.380 9.97 27.32 /100WBC
WBC increased with classification results of poor reliability that were blocked; RBC and HGB decreased; extremely low PLT count.
In the WNB channel, a large number of NRBCs were observed, and some WBC particles extended upwards, indicating the
presence of a large amount of abnormal cells. In the DIFF scattergram, the particles in the Lym and Neu regions extended
together towards the high-fluorescence area and eventually merged, causing particle clusters to be indistinguishable and
presenting a droplet-like appearance, indicating the presence of a large number of immature granulocytes and blasts.
Peripheral blood morphology results on Aug. 24

Analysis time 08:57, Aug. 24, 2022
White blood cells

White blood cells 325 100%
L Segmented neutrophils 2 0.6
Band neutrophils 2 0.6
L Lymphocytes 11 3.4
L Monocytes 2 0.6
Immature
Eosinophils
L 1 0.3
granulocytes:
Metamyelocytes 4 1.2
! Myelocytes 39 12.0
! Promyelocytes 49 15.1
! Blasts 215 66.2
Non-white blood cells 92 %

! Nucleated RBCs 8 2.5
Smudge cells 79 24.3

BlastsBlasts
PseudoPseudo
Pelger–Huët
Pelger–Huët
anomalyanomaly
was observed
was observed
in somein neutrophilic
some neutrophilic
metamyelocytes
metamyelocytes
and bandand neutrophils.
band neutrophils.
The blasts
The blasts
accounted
accounted
for 66.2%,
for 66.2%,
variedvaried
in sizes,
inand
sizes,were
andgenerally
were generally
larger larger
compared
compared
with previous
with previous
results,results,
with 2–3with
nucleoli
2–3 nucleoli
visiblevisible
in somein blasts.
some blasts.
Discussion
Discussion
Although
Although
scattergrams
scattergrams
cannotcannot
directlydirectly
reflectreflect
the morphology
the morphologyof cells,ofthe
cells,
changes
the changes
in theirinoptical
their optical
signal signal
valuesvalues
can faithfully
can faithfully
reflectreflect
changeschanges
in cell in
morphology.
cell morphology.
For example,
For example,
in this in
case,
thisalthough
case, although
blasts blasts
appearedappeared
frequently,
frequently,
the monoclonal
the monoclonal
proliferation
proliferation
was inhibited
was inhibited
by thebydrug
theand
drugthe
andtranscriptional
the transcriptional
and translational
and translational
activities
activities
of nucleic
of nucleic
acids were
acidsweakened.
were weakened.
Meanwhile,
Meanwhile,
the cellthe
volume
cell volume
was reduced
was reduced
and chromatin
and chromatin
was aggregated.
was aggregated.
As a result,
As a result,
the binding
the binding
of fluorescent
of fluorescent
dye wasdyenot
wasas not as
pronounced
pronounced
as in typical
as in typical
blasts blasts
duringduring
the CBC,theand
CBC,Lym
andandLymMonandparticle
Mon particle
clustercluster
distribution
distribution
were slightly
were slightly
suppressed
suppressed
in the in the
fluorescence
fluorescence
direction
direction
on theon DIFF
thescattergram.
DIFF scattergram.
Nevertheless,
Nevertheless,
the Lymtheparticle
Lym particle
clustercluster
was morewas skewed
more skewed
to the to
right
thethan
rightthat
than that
under under
normalnormal
circumstances,
circumstances,
indicating
indicating
the presence
the presence
of abnormal
of abnormal
cells. Incells.
the In
lastthe
examination,
last examination,
a largeanumber
large number
of myeloblasts
of myeloblasts
and immature
and immature
granulocytes
granulocytes
proliferated
proliferated
and were
andreleased,
were released,
rendering
rendering
the DIFFthescattergram
DIFF scattergram
more distinct
more distinct
features.
features.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 10 |
Case Booklet 10
Case 02
Acute promelocytic leukemia (APL)
02
The patient was a 52-year-old female, previously healthy, who presented to the hospital on Nov. 1 with left ear
bleeding without any obvious cause (which later stopped spontaneously). One week prior to the visit, the patient
had experienced fatigue without obvious cause. The skin showed no petechiae or ecchymoses, and there was no
hepatosplenomegaly or superficial lymphadenopathy.
CBC results
CBC results on Nov. 1

RBC PLT
WBC & H 93.05 10^9/L
Neu# & R L 1.15 10^9/L
Lym# **** 10^9/L
Mon# **** 10^9/L
Eos# L 0.00 10^9/L
Bas# H 0.90 10^9/L
IMG# R 0.80 10^9/L
Neu% & R L 1.2 % 0 100 200 fL 0 10 20 30 fL
Lym% **** %
Mon% **** %
Eos% L 0.0 %
Bas% 1.0 % DIFF WNB
IMG% R 0.9 %
FL FS
RBC L 2.84 10^12/L
HGB L 89 g/L
HCT L 26.6 %
MCV 93.6 fL
MCH 31.2 pg
MCHC 333 g/L
RDW-CV 15.1 %
SS FL
RDW-SD 52.0 fL
PLT L 17 10^9/L
MPV 8.9 fL Alarm
PDW H 18.0
PCT L 0.015 % - Abn. WBC scattergram - Basophilia
P-LCC L 4 10^9/L - Blasts? - Leukocytosis
P-LCR 22.3 % - Abn Lymph/blast? - Anemia
NRBC# 0.195 10^9/L - Immature Gran? - Thrombocytopenia
NRBC% 0.21 /100WBC
WBC increased with poor classification reliability; RBC and HGB decreased; extremely low PLT count.
The WNB channel showed the presence of NRBCs, and some particles extended upward. The DIFF channel
showed particles in the Neu region extending upward to the left and merging with particles in the Mon region
to advance towards the high-fluorescence region, leading to some particles entering the abnormal
lymphocytes/blasts region. The instrument also gave an alarm.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
Whitecells
blood cells Abnormal
Abnormal
promyelocytes
promyelocytes
White blood
Whitecells
blood cells 500 500 100% 100%
L Segmented
L Segmented
neutrophils
neutrophils
6 6 1.2 1.2
Band neutrophils
L Lymphocytes
L Lymphocytes 5 5 1.0 1.0
L Eosinophils
L Eosinophils 2 2 0.4 0.4
Metamyelocytes
Metamyelocytes 1 1 0.2 0.2
Promyelocytes
Promyelocytes 4 4 0.8 0.8
! Blasts! Blasts 473 473 94.6 94.6
ReactiveReactive
lymphocytes
lymphocytes8 8 1.6 1.6
Non-white
Non-white
blood cells
blood cells70 70 % %
! Nucleated
! Nucleated
RBCs RBCs 4 4 0.8 0.8
SmudgeSmudge
cells cells 60 60 12.0 12.0
PlateletsPlatelets
EstimatedEstimated Estimation
Estimation
PLT estimate
PLT estimate result result methodmethod
Platelet Platelet concentration29*10^9/L
concentration 29*10^9/L Manual Manual
Red blood
Redcells
blood cells
! ! Anisocytosis
Anisocytosis 3+ 3+
Macrocytes
Macrocytes 0 0 1.2 1.2 Results
Results
fromfrom
manual
manual
re-classification
re-classification
! Microcytes
! Microcytes 3+ 3+ 40.4 40.4

Segmented
Segmented
neutrophils
neutrophils
accounted
accounted
for 1.2%,
for band
1.2%, band
neutrophils
neutrophils
accounted
accounted
for 0.2%,
for metamyelocytes
0.2%, metamyelocytesaccounted
accounted
for 0.2%,
for promyelocytes
0.2%, promyelocytes
accounted
accounted
for for
Hypochromic
Hypochromic
0.6%, lymphocytes
0.6%, lymphocytes
accounted
accounted
for 1%,forand
1%,abnormal
and abnormal
promyelocytes
promyelocytes
Polychromasia
Polychromasia 0 0 0.6 0.6
accounted
accounted
for 94.8%.
for 94.8%.
Abnormal
Abnormal
promyelocytes
promyelocytes
exhibited
exhibited
irregular
irregular
cell cell
bodiesbodies
and nuclei
and nuclei
with twisting
with twisting
and folding
and folding
patterns.
patterns.
Chromatins
Chromatins
were fine
were fine
! Poikilocytosis
! Poikilocytosis 1+ 1+ and nucleoli
and nucleoli
were visible.
were visible.
The internal
The internal
and external
and external
plasmaplasma
was visible
was visible
in fewin few
! Schistocytes
! Schistocytes 1+ 1+ 1.7 1.7 cells, with
cells,indistinct
with indistinct
granules
granules
while while
Auer'sAuer's
bodiesbodies
were visible
were visible
in thein the
Echinocytes
Echinocytes 0 0 0.2 0.2 cytoplasm
cytoplasm
of some
of some
abnormal
abnormal
cells. cells.
Elliptocytes
Elliptocytes 0 0 0.4 0.4
Ovalocytes
Ovalocytes 0 0 8.7 8.7
Stomatocytes
Target cells
Teardrop
Teardrop
Other
Other
examinations
examinations
Item Item Parameter
Parameter
Result Result
Reference
Reference
range range Item Item Result Result
PT PT 16.3 16.3 9.4-12.59.4-12.5 Bone Bone APL cells
APLaccounted
cells accounted
for 86%,forwith
86%,POX-5,
with POX-5,
+37, +++28,
+37, +++28,
++++30/100,
++++30/100,
suggesting
suggesting
APTT APTT 23.8 23.8 25.4-38.4
25.4-38.4 marrowmarrow APL. Please
APL. take
Pleaseinto
take
account
into account
clinical clinical
findingsfindings
and other
andgenetic
other genetic
tests. tests.
TT TT 18.6 18.6 11.0-17.8

11.0-17.8 The immature
The immature
myeloidmyeloid
cells accounted
cells accounted
for 94.55%
for 94.55%
of the nucleated
of the nucleated
cells in cells
the in the
Coagulation
Coagulation bone marrow,
bone marrow,
with large
withside-scatter
large side-scatter
angles;angles;
FIB FIB 118 118 200-400200-400
stronglystrongly
positivepositive
for CD9;for CD9;
DD DD 2574 2574 <250 <250 Flow Flow positivepositive
for CD117,
for CD117,
CD45, CD34,
CD45,CD64,
CD34,CD13,
CD64,CD33,
CD13,CD123,
CD33, CD123,
and cMPO;
and cMPO;
cytometry
cytometry weakly weakly
positivepositive
for CD7for
andCD7CD71;
and CD71;
FDP FDP 45.90 45.90 <5.00 <5.00 negativenegative
for CD22,
forCD10,
CD22,CD19,
CD10,CD38,
CD19,CD14,
CD38,CD15,
CD14,CD11b,
CD15, CD11b,
CD25, CD11c,
CD25, CD11c,
DR, DR,
K K 2.94 2.94 3.50-5.30mmol/L
3.50-5.30mmol/L GlyA, cCD79a,
GlyA, cCD79a,
cCD3, andcCD3,
other
andantigens
other antigens
Chemistry
Chemistry LDH LDH 691 691 120-250U/L
120-250U/LChromosome
Chromosome46, XX, 46,
t(15;XX,
17)(q24;
t(15; 17)(q24;
q21) q21)
CRP CRP 6.2 6.2 <3.0mg/L
<3.0mg/L Gene Gene PML-RARA
PML-RARA
74.49%,74.49%,
FLT-ITDFLT-ITD
(high) 44.23%
(high) 44.23%
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 12 |
Case Booklet 12
Case analysis
The main clinical manifestations of the patient were asthenia and bleeding; CBC showed anemia with markedly elevated WBCs
and markedly reduced platelets. The coagulation results were abnormal, with markedly increased D-dimer, suggesting a
tendency for DIC. Lactate dehydrogenase (LDH) was markedly elevated, while typical abnormal promyelocytes were observed in
both peripheral blood and bone marrow. The diagnosis of acute promyelocytic leukemia (high-risk type) was further confirmed
with the results of flow cytometry and karyotype analysis.
Starting on Nov. 1, platelets and fresh frozen plasma (Fib supplementation) were given for supportive treatment to correct DIC
tendency.
Hydroxyurea, cytarabine, and mitoxantrone were temporarily given from Nov. 1 to Nov. 4 for WBC reduction therapy;
Arsenic + ATRA induction therapy was started on Nov. 3;
CBC results on Nov. 5

RBC PLT
WBC 4.48 10^9/L
Neu# R L 0.77 10^9/L
Lym# **** 10^9/L
Mon# **** 10^9/L
Eos# L 0.00 10^9/L
Bas# H 0.12 10^9/L
IMG# R 0.04 10^9/L 0 100 200 fL 0 10 20 30 fL
Neu% R L 17.2 %
Lym% **** %
Mon% **** %
DIFF WNB
Eos% L 0.1 %
Bas% H 2.8 % FL FS
IMG% R 1.0 %
RBC L 2.36 10^12/L
HGB L 74 g/L
HCT L 22.1 %
MCV 93.8 fL
MCH 31.6 pg
SS FL
MCHC 337 g/L
RDW-CV 14.5 %
RDW-SD 50.2 fL Alarm
PLT L 49 10^9/L
- Abn. WBC scattergram
MPV 8.3 fL
- Blasts?
PDW 16.6 - Abn Lymph/blast?
PCT L 0. 041 % - Atypical Lymph?
P-LCC L 8 10^9/L
- Neutropenia
- Anemia
P-LCR 15.5 % - Thrombocytopenia
NRBC# 0.000 10^9/L
NRBC% 0.00 /100WBC

CBC CBC
results
results
on Feb.
on Feb.
10 10
Parameter
Parameter
Alarm Alarm
Result Result
Unit Unit
RBC RBC PLT PLT DIFFDIFF
WBC WBC L 1.11
L 1.11
10^9/L 10^9/L
Neu# Neu# L 0.70
L 0.70
10^9/L 10^9/L FL FL
Lym# Lym# L 0.38
L 0.38
10^9/L 10^9/L
Mon# Mon# L 0.01
L 0.01
10^9/L 10^9/L
Eos# Eos# 0.02 0.02
10^9/L 10^9/L
Bas# Bas# 0.00 0.00
10^9/L 10^9/L
IMG# IMG# 0.00 0.00
10^9/L 10^9/L
0 0 100 100200 200 fL fL
0 10
0 10
20 20 30 FL30 FL fL fL
Neu% Neu% 62.2 62.2
% %
SS SS
Lym% Lym% 34.4 34.4
% %
Mon% Mon% L 1.0L 1.0% %
Eos% Eos% 2.2 2.2% % WNBWNB Alarm
Alarm
Bas% Bas% 0.2 0.2% %
IMG% IMG% 0.1 0.1% %
FS FS
- Lymphopenia
- Lymphopenia
RBC RBC L 2.87
L 2.87
10^12/L10^12/L - Neutropenia
- Neutropenia
HGB HGB L 91L 91g/L g/L - Leukocytopenia
- Leukocytopenia
HCT HCT L 27.2
L 27.2
% % - Anisocytosis
- Anisocytosis
MCV MCV 94.8 94.8
fL fL
MCH MCH 31.6 31.6
pg pg
MCHC MCHC 333 333
g/L g/L FL FL
RDW-CVRDW-CV H 18.5
H 18.5
% %
RDW-SDRDW-SD H 64.7
H 64.7
fL fL
After treatment,
After treatment,
some someimprovement
improvement in anemia
in anemia
and thrombocytopenia
and thrombocytopenia was achieved,
was achieved,
PLT PLT 123 123
10^9/L 10^9/L and theandWBC
theconcentration
WBC concentration also decreased
also decreasedsignificantly.
significantly.
The scattergram
The scattergram
showed showed
that that
MPV MPV 8.3 8.3fL fL the decreased
the decreased
WBCs WBCs
were mainly
were mainly
particlesparticles
in thein region
the region
of monocytes
of monocytes
and abnormal
and abnormal
PDW PDW 16.0 16.0 cells. Because
cells. Because
abnormalabnormal
cells have
cells fewer
have fewer
granulesgranules
and a and
higher a higher
contentcontent
of intracellular
of intracellular
PCT PCT L 0.103
L 0.103
% % nucleicnucleic
acid material,
acid material,
they typically
they typically
fall in fall
thein Mon
theregion
Mon region
of theof DIFF
thescattergram,
DIFF scattergram,
P-LCC P-LCC L 19L 1910^9/L 10^9/L leadingleading
to a false
to aincrease
false increase
in Mon. in Therefore,
Mon. Therefore,in practice,
in practice,
it is advisable
it is advisable
to set to set
P-LCR P-LCR 15.0 15.0
% %
corresponding
corresponding
retesting
retesting
rules for
rules
Mon forelevation
Mon elevation
and toand perform
to perform
morphology
morphology
screening
screening
of abnormal
of abnormal
cells for
cells
samples
for samples
that trigger
that trigger
the rules.
the rules.
NRBC# NRBC# 0.000 0.000
10^9/L 10^9/L
NRBC%NRBC% 0.00 0.00
/100WBC
/100WBC
Discussion
Discussion
AcuteAcute
promyelocytic
promyelocytic
leukemia
leukemia
(APL) (APL)
is an acute
is an acute
myeloid
myeloid
leukemia
leukemia
featured
featured
by malignant
by malignant
proliferation
proliferation
of abnormal
of abnormal
promyelocytes
promyelocytes
and cytogenetic
and cytogeneticabnormalities
abnormalities
t(15;17)(q22;q12)
t(15;17)(q22;q12)
and PML-RARα.
and PML-RARα.
Its morphological
Its morphological
characteristics
characteristics
are are
equivalent
equivalent
to those
to those
of acuteof acute
promyelocytic
promyelocytic
leukemia
leukemia
(M3 subtype)
(M3 subtype)
in theinFAB
theclassification
FAB classification
scheme.
scheme.
AML-M3AML-M3
emphasizes
emphasizes
abnormal
abnormal
promyelocyte
promyelocytemorphology,
morphology,
with morphological
with morphological
features
features
including
including
internal
internal
and external
and external
plasma,
plasma,
"buttock"
"buttock"
and and
"butterfly"
"butterfly"
cells, as
cells,
wellasaswell
faggot
as faggot
cells. cells.
In addition
In addition
to theto
common
the common
clinical
clinical
features
features
of AML,
of APL
AML,has
APLthe
has
following
the following
characteristics:
characteristics:
Granules
Granules
in thein cytoplasm
the cytoplasm
of abnormal
of abnormal
promyelocytes
promyelocytes
containcontain
a largea amount
large amount
of procoagulant
of procoagulant
enzymes,
enzymes,
often often
causing
causing
patients
patients
to develop
to develop
DIC. Skin
DIC.and
Skinmucous
and mucous
membrane
membrane
bleeding
bleeding
is the is
most
the obvious
most obvious
sign, followed
sign, followed
by gastrointestinal
by gastrointestinal
tract, tract,
urinaryurinary
tract, respiratory
tract, respiratory
tract, and
tract,vaginal
and vaginal
bleeding,
bleeding,
while while
intracranial
intracranial
bleeding,
bleeding,
as theasmost
the severe
most severe
case, iscase,
oneisofone
theof
causes
the causes
of of
death.death.
In thisIncase,
this the
case,
patient
the patient
experienced
experienced
bleeding
bleeding
in thein
earthe
canal
ear canal
that stopped
that stopped
spontaneously,
spontaneously,
but DIC
butoccurred
DIC occurred
soon after
soon after
hospitalization.
hospitalization.
Fortunately,
Fortunately,
the diagnosis
the diagnosis
and hospitalization
and hospitalization
were timely.
were timely.
All-trans
All-trans
retinoic
retinoic
acid (ATRA)
acid (ATRA)
can induce
can induce
the differentiation
the differentiation
of APLofcells
APLinto
cellsmature
into mature
cells, while
cells, while
arsenicarsenic
trioxide
trioxide
(ATO) (ATO)
can can
induceinduce
their apoptosis,
their apoptosis,
resulting
resulting
in a high
in aremission
high remission
rate. Therefore,
rate. Therefore,
early diagnosis
early diagnosis
and treatment
and treatment
of APLofareAPLkeyare
tokey
improving
to improving
the remission
the remission
rate. rate.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 14 |
Case Booklet 14
Case 03
Acute myeloblastic leukemia with maturation (M2)
03
The patient, a 60-year-old female, was admitted to the hospital on Aug. 16, 2021 with dizziness and anemia.
CBC results

RBC PLT
WBC & H 34.99 10^9/L
Neu# & R H 13.25 10^9/L
Lym# **** 10^9/L
Mon# **** 10^9/L
Eos# R 0.04 10^9/L
Bas# R H 0.27 10^9/L
IMG# R 3.56 10^9/L
Neu% & R L 37.8 % 0 100 200 fL 0 10 20 30 fL
Lym% **** %
Mon% **** %
Eos% R L 0.2 %
Bas% R 0.8 %
DIFF WNB
IMG% R 10.2 % FL FS
RBC L 2.70 10^12/L

HGB L 89 g/L
HCT L 27.2 %
MCV H 100.8 fL
MCH 33.1 pg
MCHC 328 g/L
RDW-CV 14.1 % SS FL
RDW-SD 51.5 fL
PLT L 31 10^9/L
MPV 10.5 fL
Alarm
PDW H 17.1
PCT L 0.033 % - Abn. WBC scattergram
- Blasts?
P-LCC L 10 10^9/L
- Abn Lymph/blast?
P-LCR 31.3 %
- Immature Gran
NRBC# 2.762 10^9/L
NRBC% 7.89 /100WBC
WBC increased with poor classification reliability; moderate anemia; PLT decreased.
In the WNB channel, the NRBC region was significantly dense, and the WBC, NRBC, and Bas particle clusters were
clearly distinguished, ensuring the accuracy of WBC. In the DIFF scattergram, the particles in the Mon region were
dense and could not be effectively distinguished from Lym, with a large number of particles extending up to the
abnormal cell region, suggesting the presence of abnormal cells. In addition, the left margin of the mixed Lym and
Mon particle cluster was concave to the right, suggesting that the abnormal cells were possibly of myeloid lineage.
The Neu particle cluster extended toward the high-fluorescence region, suggesting a left shift of the nucleus.

Peripheral blood morphology examination
White blood cells
L Lymphocytes
Monocytes
7 3.5
Blasts
6 3.0
H Basophils 13 6.5
! Metamyelocytes 15 7.5
! Myelocytes 5 2.5
Promyelocytes 1 0.5
! Blasts 125 62.5
! Nucleated RBCs 15 7.5
Large platelets 1
Platelets Estimation
PLT estimate Estimated result method
Platelet concentration 12*10^9/L Automated
Platelet concentration 18*10^9/L Manual
Red blood cells
Size Degree %
! Anisocytosis 2+
Macrocytes 0 2.0
! Microcytes 2+ 11.9
Myelocytes
Color Degree %
! Hypochromic cells 2+ 14.9
Polychromasia 0 1.0
Shape Degree %
Poikilocytosis 0
Schistocytes 0 1.0
Echinocytes 0 0.2
Elliptocytes 0 0.0
Ovalocytes 0 4.4
Stomatocytes 0 0.4
Target cells 0 0.2
Teardrop cells 0 2.5
Results from manual re-classification
The immature granulocytes accounted for 10.5%, which were mainly metamyelocytes; blasts accounted for 62.5%; NRBCs
accounted for 7.5%, with occasional large platelets; no platelet aggregation was observed. The PLT estimate was generally
consistent with the CBC result. Blasts showed oval cell bodies, eccentric nucleus, fine sandy chromatins, 2–3 nucleoli, and
blue transparent cytoplasm. Abnormal myelocytes were also visible with pink cytoplasm, but the nucleoli were still visible in
the nucleus, showing old nuclei and young cytoplasm.
Bone marrow cytology examination

Blasts accounted for 84.5% and histochemical staining showed POX+.
Acute myeloid leukemia with a predilection for M2, further subtyping is recommended through integration of flow cytometry
and relevant molecular biology testing.
Case analysis
Characteristics of M2 (acute myeloid leukemia with partial differentiation):
Hemogram: Significant anemia, moderate leukocytosis similar to M1, mainly myeloblasts and promyelocytes, and moderate to severe thrombocytopenia.
Myelogram: A diagnosis of this subtype can be made with 30%–89% blasts in bone marrow (NEC) with morphological abnormalities; monocytes < 20%,
promyelocytes and cells in earlier stages > 10%.
Cell histochemical staining: POX and SBB staining were positive; PAS staining: most blasts were negative, most promyelocytes were weakly positive with
fine granular positivity; neutrophilic alkaline phosphatase (NAP): activity was obviously decreased, even disappearing. When accompanied by infection,
NAP score might increase transiently.
Based on the myelogram characteristics and histochemical staining, the diagnosis of acute myeloid leukemia M2 subtype was
favored. Further subtyping requires the results of flow cytometry and relevant genetic testing.

Case 04
Acute myelomonocytic leukemia (AMML)
04
The patient was a 49-year-old female who presented with asthenia more than 10 days ago with no obvious cause.
She had a medical history of "malignant breast tumor" for 7 years and had undergone surgical treatment, with 1
month of post-operative radiotherapy and 8 cycles of chemotherapy.
CBC results

RBC PLT
WBC & L 0.95 10^9/L
Neu# & R L 0.39 10^9/L
Lym# & R L 0.46 10^9/L
Mon# R L 0.06 10^9/L
Eos# L 0.00 10^9/L
Bas# 0.04 10^9/L
IMG# R 0.01 10^9/L
0 100 200 fL 0 10 20 30 fL
Neu% & R L 40.6 %
Lym% & R H 47.9 %
Mon% R 6.8 %
Eos% L 0.1 %
DIFF WNB
Bas% H 4.6 % FL FS
IMG% R 1.2 %
RBC L 1.43 10^12/L
HGB L 50 g/L
HCT L 15.6 %
MCV H 109.1 fL
MCH H 35.3 pg
SS FL
MCHC 323 g/L
RDW-CV 15.8 %
RDW-SD H 62.6 fL Alarm
PLT L 30 10^9/L
MPV 11.8 fL - Pancytopenia - Leukocytopenia
PDW H 18.2 - Blasts? - Anemia
- Abn Lymph/blast? - Thrombocytopenia
PCT L 0.035 %
- NRBC Present
P-LCC L 10 10^9/L
- Lymphopenia
P-LCR 33.0 % - Neutropenia
NRBC# 0.012 10^9/L
NRBC% 1.24 /100WBC
Decreased trilineage, severe anemia, increased Bas%.

The particle clusters in the Diff scatter plot were clearly defined, and the Mon particle clusters were distributed in
the high-fluorescence region, which were suspected to be blasts.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
White cells
blood cells
White blood
White
cells
blood cells 200 200 100% 100%
BlastsBlasts
L Segmented
L Segmented
neutrophils
neutrophils 64 64 32 32
Band neutrophils
Lymphocytes
Lymphocytes 53 53 26.5 26.5
L Monocytes
L Monocytes 1 1 0.5 0.5
H Basophils
H Basophils 4 4 2.0 2.0
! ! Metamyelocytes
! ! Myelocytes
Myelocytes 2 2 1.0 1.0
! Blasts! Blasts 66 66 33.0 33.0
Non-white
Non-white
blood cells
! ! Nucleated
Nucleated RBCs RBCs 2 2 1.0 1.0
Giant platelets
Giant platelets 1 1
Large platelets
Large platelets 7 7
Smudge cells
Smudge cells 10 10 5.0 5.0
Platelets
Platelets
EstimationEstimation
PLT estimate
Estimated
result method
result method
Platelet concentration
40*10^9/L Automated
Platelet concentration 62*10^9/L
62*10^9/L
Manual Manual
Red blood
Red cells
blood cells
! Anisocytosis
Macrocytes
! ! Microcytes
Microcytes 2+ 2+ 13.2 13.2
! Hypochromic
! Hypochromic
cells cells 3+ 3+ 53.9 53.9
Polychromasia
Poikilocytosis
Poikilocytosis
Schistocytes
Schistocytes
0
0
0
0 0.8 0.8
Results
Results
fromfrom
manual
manual
re-classification
re-classification
Echinocytes
Echinocytes 0 0 0.3 0.3
Immature
Immature
granulocytes
granulocytes
accounted
accounted
for 3%for
and3% blasts
and accounted
blasts accounted
for 33%;
forthe
33%; the
Elliptocytes
cell bodies
cell bodies
were large
wereand
large
irregular
and irregular
in shape;
in shape;
the cytoplasm
the cytoplasm
was darkwasblue,
dark blue,
Ovalocytes
and cytoplasm
and cytoplasm
of someof cells
somecontained
cells contained
dust-like
dust-like
granules;
granules;
the chromatins
the chromatins
Stomatocytes
were coarse
were coarse
and granular;
and granular;
1-2 large
1-2and
large
pronounced
and pronounced
nucleoli
nucleoli
were visible;
were visible;
Target cells
cup-like
cup-like
blasts were
blastsoccasionally
were occasionally
observed.
observed.
Pancytopenia,
Pancytopenia,
blasts in
blasts in
TeardropTeardrop
peripheral
peripheral
blood blood
> 20%,>suggesting
20%, suggesting
AML. AML.
Other
Other
examinations
examinations
Item Item Result Result
AbnormalAbnormal
granulocytic
granulocytic
hyperplasia;
hyperplasia;
granulocytes
granulocytes
at all stages
at all
ofstages
maturation
of maturation
were visible,
werewith
visible,
myeloblasts
with myeloblasts
accountingaccounting
for 27%, mainly
for 27%,
intermediate
mainly intermediate
and late-stage
and late-stage
Bone marrow granulocytes.
Bone marrow granulocytes.
MonoblastsMonoblasts
and promonocytes
and promonocytes
accounted accounted
for 39% and
for 39%
mature
andmonocytes
mature monocytes
accounted accounted
for 6%. MPO
for 6%.
(+); MPO
NAP (35%,
(+); NAP
54 (35%,
points).
54Extracellular
points). Extracellular
iron (+), iron (+),
erythroblasts
erythroblasts
with intracellular
with intracellular
iron wereiron
rare.were
Suggested
rare. Suggested
diagnosis:diagnosis:
AML-M4b. AML-M4b.
Flow cytometry
Flow cytometry A group of
A group
abnormal
of abnormal
myeloid blasts
myeloidwere
blasts
observed,
were observed,
accounting
accounting
for 26.04%
forof26.04%
the v cells,
of thewhich
v cells,
was which
consistent
was consistent
with the AML
with phenotype
the AML phenotype
Chromosome
Chromosome 46,XX,t(6:9)(p23;q34.1)
46,XX,t(6:9)(p23;q34.1)
Gene Gene DEK-CANDEK-CAN

positive. FLT3-ITD
positive. FLT3-ITD
allelic ratio:
allelic
0%.ratio:
NPM1(-).
0%. NPM1(-).
FLT3-TKDFLT3-TKD
negative negative
Case
Case
analysis
analysis
Acute Acute
granulocytic
granulocytic
leukemia
leukemia
(M4) is(M4)
classified
is classified
into four
intosubtypes
four subtypes
(per the
(per
classification
the classification
criteriacriteria
in China),
in China),
of which
of which
M4b isM4b
characterized
is characterized
by theby
hyperplasia
the hyperplasia
of monoblasts
of monoblasts
and promonocytes,
and promonocytes,with myeloblasts
with myeloblasts
and promyelocytes
and promyelocytes
accounting
accounting
for > 20%.
for > 20%.
The MICM
The MICM
diagnosis
diagnosis
of this of
case
thiswas
caseAML
waswith
AMLt(6;9)
with(p23;q34).
t(6;9) (p23;q34).
DEK-NUP214
DEK-NUP214
(also known
(also known
as CAN) asisCAN)
a unique
is a unique
and relatively
and relatively
rare type
rareoftype of
AML, accounting
AML, accounting
for 0.7%forto0.7%
1.8%toof1.8%
AML.ofThe
AML.translocation
The translocation
t(6;9) (p23;q34)
t(6;9) (p23;q34)
resultsresults
in the in
fusion
the fusion
of DEKofonDEK chromosome
on chromosome6 and NUP214
6 and NUP214
on chromosome
on chromosome
9, forming
9, forming
a nucleoporin
a nucleoporin
fusion fusion
proteinprotein
that actsthatasacts
an aberrant
as an aberrant
transcription
transcription
factor factor
and alters
and nuclear
alters nuclear
transport
transport
by by
binding
binding
solublesoluble
transport
transport
factors.factors.
The median
The median
onset ages
onsetinages
children
in children
and adults
and adults
are 13 are
and13 35and
years,
35 respectively.
years, respectively.
Patients
Patients
often present
often present
with anemia
with anemia
and thrombocytopenia or showor full
show blood
full blood
count count
decreased.
decreased.
The prognosis
The prognosis
is poor.isMorphologically,
poor. Morphologically,maturemature
type AMLtype AML
and acute
and myelomonocytic
acute myelomonocytic leukemialeukemia
are theare
mostthecommon.
most common. Auer bodies
Auer bodies
can becanobserved
be observed
in one-third
in one-third
of cases.
of cases.
MPO isMPO
positive,
is positive,
while while
NSE can
NSEbecan
either
be either
positivepositive
or negative.
or negative.
AboutAbout
44%–62% 44%–62%
of patients
of patients
show increased
show increased
basophils
basophils
in the inbone
the marrow
bone marrow
and peripheral
and peripheral
blood blood
(> 2%)(>(4.6%
2%) in(4.6%
peripheral
in peripheral
blood blood
for thisfor
case),
this which
case), which
is rare is
inrare
otherin types
other of
types
AML.ofMost
AML.patients
Most patients
show granulocytic
show granulocytic
and and
erythroid
erythroid
dysplasia,
dysplasia,
and ringandsideroblasts
ring sideroblasts
are observed
are observed
in some in patients,
some patients,
but megakaryocytic
but megakaryocyticdysplasiadysplasia
is rare.is rare.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 18 |
Case Booklet 18
Case 05
Thrombotic thrombocytopenic purpura (TTP)
Clinical information 05
The patient was a 64-year-old male who experienced recurrent chest tightness and dizziness for 20 days, and fever for 5 days. He
visited a local hospital and was discharged after the symptoms improved. However, he continued to experience recurrent chest
tightness and dizziness after discharge, so he returned to the hospital for further examination 10 days later, and the relevant test
results are as follows:
Item Parameter Result Item Paramet Result

TBIL 18.9μmol/L HGB 73g/L
CBC
DBIL 7.7μmol/L PLT 26*10^9/L
Chemistry IBIL 11.2μmol/L
Markedly active bone marrow hyperplasia, increased erythroid proportion,
Creatinine 115μmol/L Bone Bone
decreased myeloid proportion, and poor megakaryocyte platelet production
marrow marrow
LDH 892U/L
Idiopathic thrombocytopenic purpura was suggested and EVANS syndrome was to be excluded. The patient had poor treatment
response and experienced recurrent fever. Ten days later, he presented to the emergency department of our hospital with
symptoms of delayed response and decreased calculation ability during the emergency treatment.
CBC results
WBC & 8.37 10^9/L
RBC PLT RET
Neu# & R 6.68 10^9/L
Lym# & 0.87 10^9/L FS
Mon# 0.75 10^9/L
Eos# R 0.05 10^9/L
Bas# R 0.02 10^9/L
IMG# 0.11 10^9/L
Neu% & R H 79.7 %
Lym% & L 10.4 %
Mon% 9.0 % 0 100 200 fL 0 10 20 30 fL
Eos% R 0.6 %
FL
Bas% R 0.3 %
IMG% 1.3 %
RBC L 2.37 10^12/L
HGB L 80 g/L DIFF WNB Alarm
HCT L 23.5 %
MCV 98.9 fL FL FS - Immature Gran?
MCH 33.8 pg - Fragments?
MCHC 341 g/L
- RET Scattergram Abn.
RDW-CV H 17.2 %
RDW-SD H 58.2 fL - Anemia
PLT & L 5 10^9/L - Reticulocytosis
MPV R 7.9 fL - PLT Histogram Abn
PDW R 15.5
PCT R L 0.008 %
- Thrombocytopenia
SS FL
P-LCC R L 1 10^9/L
P-LCR R 21.9 %
IPF 5.0 %
RET# R H 0.3752 10^12/L
RET% R H 15.82 %
WBCs were generally normal; moderate anemia and extremely low PLT.
IRF R 22.8 %
In the RET scattergram, the RBC cluster extended towards the direction of low
LFR R L 77.2 %
MFR R 15.5 %
forward scattered light, even falling below the PLT particles, suggesting the
HFR R H 7.3 % presence of RBC fragments.
RHE R 30.4 pg
NRBC# 0.034 10^9/L
NRBC% 0.41 /100WBC

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
Red blood
Red blood
cells cells Schistocytes
Schistocytes
! Anisocytosis
Macrocytes
Microcytes
! Hypochromic
! Hypochromic
cells cells 3+ 3+ 25.8 25.8
Polychromasia
! Poikilocytosis
! Poikilocytosis 3+ 3+
! Schistocytes
! Schistocytes 3+ 3+ 9.0 9.0
Echinocytes
Elliptocytes
Elliptocytes 0 0 0.2 0.2 Results
Results
from manual
from manual
re-classification
re-classification
Ovalocytes
Stomatocytes
Schistocytes
Schistocytes
accounted
accounted
for 9%for
and9%were
and found
were found
as as
helmet-shaped,
helmet-shaped,
triangular,
triangular,
pointed-shaped,
pointed-shaped,
etc. etc.
Target cells
TeardropTeardrop
Other
Other
examinations
examinations
Item Item Parameter
Parameter Result Result
TBIL TBIL 45.5μmol/L

45.5μmol/L
DBIL DBIL 8.8μmol/L
8.8μmol/L
Chemistry
Chemistry IBIL IBIL 36.7μmol/L
36.7μmol/L
Creatinine
Creatinine 106μmol/L
106μmol/L
LDH LDH 1070U/L
1070U/L
ActivityActivity <6% <6%
ADAMTS13
ADAMTS13
Titer Titer <0.6BU<0.6BU
CaseCase
analysis
analysis
Due toDue
the to
failure
the failure
to diagnose
to diagnose
Thrombotic
Thrombotic
thrombocytopenic
thrombocytopenic purpura
purpura
(TTP) and
(TTP)initiate
and initiate
corresponding
corresponding
treatment
treatment
in a timely
in a timely
manner,manner,
the patient's
the patient's
condition
condition
gradually
gradually
worsened.
worsened.
The disease
The disease
progressed
progressed
from anemia
from anemia
and thrombocytopeniato fevertoand
fever and
neurological
neurological
symptoms,
symptoms,
with awith
gradual
a gradual
decrease
decrease
in PLT in
andPLTgradual
and gradual
increases
increases
in IBIL in
andIBILLDH.
andFinally,
LDH. Finally,
idiopathic
idiopathic
thrombocytopenic
thrombocytopenicpurpurapurpura
and EVANS
and EVANS
syndrome
syndrome
were excluded
were excluded
by theby
discovery
the discovery
of intravascular
of intravascular
hemolysis
hemolysis
and schistocytes
and schistocytes
in peripheral
in peripheral
blood blood
morphology
morphology
examination.
examination.
Patients
Patients
with Thrombotic
with Thrombotic
thrombocytopenic
thrombocytopenic
purpura purpura
(TTP) suffer
(TTP) from
suffersignificant
from significant
thrombocytopenia
thrombocytopenia and anemia
and anemia
due todue
loose
to loose
platelets
platelets
or fibrin
or depositing
fibrin depositing
in the in
numerous
the numerous
small blood
small blood
vessels,vessels,
causing causing
damagedamage
to passing
to passing
platelets
platelets
and RBCs.
and The
RBCs.
decrease
The decrease
in ADAMTS13
in ADAMTS13
activityactivity
leads toleads
the to
accumulation
the accumulation
of larger
of larger
vWF aggregates
vWF aggregateson endothelial
on endothelial
cells, forming
cells, forming
many platelet-vWF
many platelet-vWF
thrombithrombi
that consume
that consume
platelets,
platelets,
resulting
resulting
in thrombocytopenia.
in thrombocytopenia.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 20 |
Case Booklet 20
Case 06
Chronic myelomonocytic leukemia (CMML)
06
The patient was a 56-year-old male who was admitted for treatment on Aug. 14 due to fever and hepatosplenomegaly.
CBC results
RBC PLT
WBC H 57.10 10^9/L
Neu# R H 21.86 10^9/L
Lym# R H 4.91 10^9/L
Mon# R H 30.26 10^9/L
Eos# R L 0.01 10^9/L
Bas# R 0.09 10^9/L
IMG# R 3.54 10^9/L
0
Neu% R L 38.3 %
0 100 200 fL 0 10 20 30 fL
Lym% R L 8.6 %
Mon% R H 53.0 %
Eos% R L 0.0 %
Bas% R 0.1 %
DIFF WNB
IMG% R 6.2 %
RBC L 1.85 10^12/L FL FS
HGB L 54 g/L
HCT L 16.6 %
MCV 89.5 fL
MCH 29.3 pg
MCHC 328 g/L
RDW-CV 16.0 %
RDW-SD 52.9 fL
PLT & L 60 10^9/L SS FL
MPV R H 14.6 fL
PDW
PCT
R
R L
16.3
0.064 %
RET Alarm
P-LCC R 37 10^9/L
FS
P-LCR R H 61.0 % - Blasts?
IPF H 37.7 % - Abn Lymph/blast?
RET# L 0.0175 10^12/L - Immature Gran?
RET% 0.94 % - Left Shift?
IRF H 31.2 %
……
LFR L 68.8 %
MFR H 25.1 %
HFR H 6.1 % FL
RHE 32.1 pg
WBC increased, mainly Mon; Neu#, Lym#, and Mon# increased; severe anemia; PLT decreased; IPF and IRF increased.
The boundaries of each particle cluster in the Diff scattergram were clear, and particles in the Mon region were significantly
dense and extended in the high-fluorescence direction, suggesting the possible presence of myeloblasts and
promyelocytes. The Neu particle cluster also extended upwards to a higher region, suggesting the presence of myelocytes
and metamyelocytes. Increased IPF and IRF suggested strong hematopoietic function of erythrocyte and platelet.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
White cells
blood cells
White blood
White
cells
blood cells 205 205 100% 100%
BlastsBlasts
L L Segmented
Segmented neutrophils 51
neutrophils 51 24.9 24.9
Band neutrophils
L Lymphocytes
Monocytes
Monocytes 103 103 50.1 50.1
Metamyelocytes
! Myelocytes
! Myelocytes 4 4 2.0 2.0
! Blasts! Blasts 3 3 1.5 1.5
! Reactive
! lymphocytes
Reactive lymphocytes 15 15 7.3 7.3
Non-whiteNon-white
blood cells
Giant platelets
Giant platelets 1 1
Large platelets
Large platelets 9 9
Smudge cells
Smudge cells 58 58 28.3 28.3
Platelets
Platelets
PLT estimate
PLT estimate EstimatedEstimated
result result
Estimation
Estimation
method method
Platelet concentration 54*10^9/L54*10^9/L Automated
Automated
Platelet concentration 66*10^9/L66*10^9/L Manual Manual
Red blood
Red cells
blood cells
! Anisocytosis
Macrocytes
Microcytes
Hypochromic
! Hypochromic
cells cells 2+ 2+ 10.8 10.8
!
Results
Results
from from
manual
manual
re-classification
re-classification
Polychromasia
Poikilocytosis
Poikilocytosis 0 0
Immature
Immature
granulocytes
granulocytes
accounted
accounted
for 3.5%
for and
3.5%myeloblasts
and myeloblasts
and and
Schistocytes
Schistocytes 0 0 0.2 0.2 promyelocytes
promyelocytes
accounted
accounted
for 6.3%;
for 6.3%;
somesome
cells had
cellslarger
had larger
cell cell
Echinocytes
Echinocytes 0 0 0.3 0.3 bodiesbodies
with scant
with scant
cytoplasm
cytoplasm
of blue
ofcolor;
blue color;
chromatins
chromatins
were fine,
were fine,
Elliptocytes
Ovalocytes
and nucleoli
and nucleoli
were visible;
were visible;
somesome
cells had
cellsmore
had more
cytoplasm
cytoplasm
with with
Stomatocytes
Stomatocytes 0 0 0.0 0.0 dust-like
dust-like
granules,
granules,
chromatins
chromatins
were coarse,
were coarse,
loose,loose,
and reticulate,
and reticulate,
Target cells
Target cells 0 0 0.4 0.4 and the
andnuclei
the nuclei
were twisted
were twisted
and folded.
and folded.
TeardropTeardrop
Bone
Bone
marrow
marrow
cytology
cytology
examination
examination
Myelocytes
Myelocytes
and cells
andincells
earlier
in earlier
stagesstages
were visible,
were visible,
with increased
with increased
proportion
proportion
of neutrophilic
of neutrophilic
metamyelocytes;
metamyelocytes;
unbalanced
unbalanced
nucleus
nucleus
and cytoplasm
and cytoplasm
growth growth
as wellasaswell
degranulation
as degranulation
were observed
were observed
in some
in some
cells; eosinophils
cells; eosinophils
were visible.
were visible.
BlastsBlasts
accounted
accounted
for 2.5%;
for 2.5%;
monocyte
monocyte
percentage
percentage
was high;
was high;
premonocytes
premonocytes
were visible.
were visible.
The morphology
The morphology
suggested
suggested
chronic
chronic
myelomonocytic
myelomonocytic
leukemia.
leukemia.
Further
Further
diagnosis
diagnosis
was recommended
was recommended
through
through
flow flow
cytometry
cytometry
and CMML-related
and CMML-related
genetic
genetic
testing.
testing.
CaseCase
analysis
analysis
Chronic
Chronic
myelomonocytic
myelomonocytic
leukemia
leukemia
(CMML)(CMML)
was previously
was previously
considered
considered
a subtype
a subtype
of myelodysplastic
of myelodysplastic
syndrome
syndrome
(MDS)(MDS)
due todue
its to its
myelodysplastic
myelodysplastic
and myeloproliferative
and myeloproliferative
characteristics.
characteristics.
In 2001,
In WHO
2001, WHO
classified
classified
CMMLCMMLas a myelodysplastic/myeloproliferative
as a myelodysplastic/myeloproliferative
neoplasm
neoplasm
(MDS/MPN).
(MDS/MPN).
According
According
to theto
FAB
theclassification
FAB classification
criteria,
criteria,
CMMLCMML
with WBC
with<WBC
13 ×<10^9/L
13 × 10^9/L
is the is
myelodysplastic
the myelodysplastic
subtypesubtype
(MD-CMML),
(MD-CMML),
and and
CMMLCMML
with WBC
with≥WBC
13 ×≥10^9/L
13 × 10^9/L
is the is
myeloproliferative
the myeloproliferative
subtype
subtype
(MP-CMML).
(MP-CMML).
According
According
to theto 2016
the WHO
2016 WHO
classification
classification
criteria,
criteria,
(i) CMML-0
(i) CMML-0
can becan
diagnosed
be diagnosed
if the blasts
if the blasts
are < 2%
are in
< 2%
peripheral
in peripheral
bloodblood
and/orand/or
< 5% in
< 5%
bone in bone
marrow; marrow;
(ii) CMML-1
(ii) CMML-1
can becan diagnosed
be diagnosedif the blasts
if the blasts
are 2%–4%
are 2%–4%
in peripheral
in peripheral
bloodblood
and/orand/or
5%–9% 5%–9%
in bone
in bone
marrow;
marrow;
(iii) CMML-2
(iii) CMML-2
can becandiagnosed
be diagnosed
if the blasts
if the blasts
are 5%–19%
are 5%–19%
in peripheral
in peripheral
blood,blood,
10%–19%10%–19%
in bonein bone
marrow,
marrow,
and/orand/or
if Auerif Auer
bodiesbodies
are present;
are present;
The patient
The patient
in thisincase
thishad
casesplenomegaly,
had splenomegaly,
markedly
markedly
increased
increased
WBCs WBCs
in peripheral
in peripheral
blood,blood,
and increased
and increased
monocytes.
monocytes.
BasedBased
on on
the diagnosis
the diagnosis
reportreport
of bone
of bone
marrowmarrow
smear,smear,
chronic
chronic
myelomonocytic
myelomonocytic
leukemia
leukemia
was suspected,
was suspected,
and flow
andcytometry
flow cytometry
and and
CMML-related
CMML-related
genetic genetic
testingtesting
were required
were required
for further
for further
diagnosis.
diagnosis.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 22 |
Case Booklet 22
Case 07
MDS with single lineage dysplasia (MDS-SLD)
07
The patient was a 55-year-old female who was admitted with a history of "diagnosed with systemic lupus erythematosus for 16
years and found to have decreased platelets for more than 1 month". She had visited the hospital 1 month ago for systemic lupus
erythematosus and was found to have decreased PLT and moderate anemia. RBC and platelet transfusions were given along with
danazol therapy. Hemoglobin and platelet levels increased after treatment. The patient refused bone marrow aspiration and
insisted on leaving the hospital. She is currently readmitted due to asthenia.
CBC results
RBC PLT
WBC & 7.66 10^9/L
Neu# & R 5.83 10^9/L
Lym# & 1.53 10^9/L
Mon# 0.30 10^9/L
Eos# R L 0.00 10^9/L
Bas# R 0.00 10^9/L
IMG# 0.19 10^9/L 0 100 200 fL 0 10 20 30 fL
Neu% & R H 76.0 %
Lym% & 20.0 %
Mon% 3.9 %
Eos% R L 0.0 % DIFF WNB
Bas% R 0.1 %
FL FS
IMG% 2.4 %
RBC L 2.67 10^12/L
HGB L 96 g/L
HCT L 30.1 %
MCV H 112.5 fL
MCH H 36.1 pg
MCHC 321 g/L SS FL
RDW-CV H 18.4 %
PLT R L 7 10^9/L
MPV R 8.5 fL - Immature Gran?
PDW R 15.0 - NRBC Present
PCT R L 0.006 % - Anisocytosis
P-LCC R L 1 10^9/L - Macrocytosis
P-LCR R 18.9 % - PLT Histogram Abn.
NRBC# 0.302 10^9/L - Thrombocytopenia
NRBC% 3.95 /100WBC
WBCs were generally normal; macrocytic anemia; extremely low PLT.

In the WNB scattergram, a large number of pink particles are visible in the NRBC region.
Parameter 1-31 2-1 2-2 2-4 3-1

WBC 3.63 5.68 6.56 6.24 7.66
PLT 7 8 44 33 7
HGB 71 62 77 77 96
RBC 1.93 1.65 2.10 2.16 2.67

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
Whitecells
blood cells Stomatocytes
Stomatocytes 46 46 6.4% 6.4%
White blood
White
cells
blood cells 100 100 100% 100%
H Segmented
H Segmented
neutrophils
neutrophils 81 81 81.0 81.0
Band neutrophils
L Lymphocytes
L Monocytes
Metamyelocytes
Non-whiteNon-white
blood cells
! Nucleated
! Nucleated
RBCs RBCs 1 1 1.0 1.0
Smudge cells
PlateletsPlatelets
PLT estimate
Estimation
Estimation
result result method method
Platelet concentration 13*10^9/L13*10^9/L
Manual Manual
Red blood
Redcells
blood cells
! Anisocytosis
! Anisocytosis 2+ 2+ Target cells
Target cells 23 23 3.2% 3.2%
! Macrocytes
! Macrocytes 3+ 3+ 30.9 30.9
MicrocytesMicrocytes 0 0 1.3 1.3
! Hypochromic
! Hypochromic
cells cells 2+ 2+ 12.1 12.1
Polychromasia
! Poikilocytosis
Schistocytes
Schistocytes 0 0 0.6 0.6
Echinocytes
Results
Results
fromfrom
manual
manual
re-classification
re-classification
Elliptocytes
OvalocytesOvalocytes 0 0 13.9 13.9
! Stomatocytes
! Stomatocytes 2+ 2+ 6.4 6.4
The WBC
Theclassification
WBC classification
resultsresults
and PLTand
estimate
PLT estimate
were consistent
were consistent
with the
with the
Target cellsTarget cells 0 0 3.2 3.2 CBC results,
CBC results,
with increased
with increased
stomatocytes.
stomatocytes.
Teardrop cells
Teardrop cells 0 0 1.4 1.4
Bone
Bone
marrow
marrow
cytology
cytology
examination
examination
Markedly
Markedly
activeactive
bone marrow
bone marrow
hyperplasia,
hyperplasia,
G/E = G/E
0.89/1.
= 0.89/1.
Granulocytic
Granulocytic
hyperplasia
hyperplasia
was fair,
was mainly
fair, mainly
intermediate
intermediate
and late-stage
and late-stage
granulocytes
granulocytes
with visible
with visible
eosinophiles.
eosinophiles.
ActiveActive
erythroid
erythroid
hyperplasia,
hyperplasia,
mainlymainly
polychromatic
polychromatic
normoblasts
normoblasts
and orthochromatic
and orthochromatic
normoblasts,
normoblasts,
with mild
withsize
mildvariation
size variation
of of
maturemature
red blood
red blood
cells. cells.
No megakaryocytes
No megakaryocytes
were observed
were observed
on theon
slide
theand
slidefew
andplatelets
few platelets
were found.
were found.
The myelogram
The myelogram
showed
showed
marked
marked
hyperplasia,
hyperplasia,
with an
with
inverted
an inverted
M/E ratio;
M/Enoratio;
megakaryocytes
no megakaryocytes
and few
andplatelets
few platelets
were observed.
were observed.
CaseCase
analysis
analysis
The preliminary
The preliminary
diagnosis
diagnosis
of thisof
case
thiswas
caseMDS
waswith
MDSsingle
with single
lineage
lineage
dysplasia
dysplasia
(MDS-SLD).
(MDS-SLD).
According
According
to theto WHO's
the WHO's
revisedrevised
classification
classification
of MDSof(4th
MDSedition,
(4th edition,
2016),2016),
the conventional
the conventional
karyotyping
karyotyping
of MDS-SLD
of MDS-SLD
is as follows:
is as follows:
any karyotype
any karyotype
that does
thatnot
doesmeet
not the
meet standard
the standard
of MDS ofwith
MDSisolated
with isolated
del(5q),
del(5q),
and dysplasia
and dysplasia
is often
is predominant
often predominant
in 1 lineage,
in 1 lineage,
with with
dysplasia
dysplasia
of 1–2oflineages
1–2 lineages
in the in
CBC.
the CBC.
Additionally,
Additionally,
the presence
the presence
of increased
of increased
stomatocytes
stomatocytes
in thisin
case
thisiscase
oftenis observed
often observed
in hereditary
in hereditary
stomatocytosis,
stomatocytosis,
disseminated
disseminated
intravascular
intravascular
coagulation,
coagulation,
liver disease,
liver disease,
systemicsystemic
lupus lupus
erythematosus,
erythematosus,
alcohol alcohol
poisoning,
poisoning,
glutathione
glutathione
deficiency,
deficiency,
hereditary
hereditary
spherocytosis,
spherocytosis,
thalassemia
thalassemia
minor,minor,
etc. Dueetc.toDue
theirtopoor
theirdeformability,
poor deformability,
stomatocytes
stomatocytes
are often
are retained
often retained
in the in
splenic
the splenic
sinuses.
sinuses.
In In
the acidic
the acidic
environment
environment
of the of
splenic
the splenic
sinus, sinus,
the destruction
the destruction
of RBCs ofisRBCs
more is than
morethree
than times
three times
greatergreater
in the in
spleen
the spleen
than inthan
otherin other
sites due
sitestodue
theto
lack
theoflack
glucose,
of glucose,
reduced reduced
available
available
ATP, and
ATP,further
and further
increased
increased
cellularcellular
permeability
permeability
to sodium.
to sodium.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 24 |
Case Booklet 24
CaseCase
08 08
MDS
MDS
with
with
excess
excess
blasts
blasts
(MDS-EB)
(MDS-EB)
0808
Clinical
Clinical
information
information
The patient,
The patient,
an 80-year-old
an 80-year-old
female,
female,
was admitted
was admitted
to thetohospital
the hospital
in early
in August
early August
with dizziness
with dizziness
and anemia.
and anemia.
CBCCBC
results
results
Parameter
Parameter Alarm Alarm Result Result Unit Unit
RBCRBC PLT PLT
WBC WBC & & H 13.04
H 13.04 10^9/L 10^9/L
Neu# Neu# & R& R 5.05 5.05 10^9/L 10^9/L
Lym# Lym# R R 2.35 2.35 10^9/L 10^9/L
Mon# Mon# R R 5.62 5.62 10^9/L 10^9/L
Eos# Eos# R LR 0.01

L 0.01 10^9/L 10^9/L
Bas# Bas# R R 0.01 0.01 10^9/L 10^9/L
IMG# IMG# R R 1.20 1.20 10^9/L 10^9/L

0 0100 100200 200fL fL 0 10
0 10
20 20
30 30
fL fL
Neu% Neu% & R& LR 38.7
L 38.7 % %
Lym% Lym% R LR 18.0

L 18.0 % %
Mon% Mon% R HR 43.1

H 43.1 % %
Eos% Eos% R LR 0.1L 0.1 % % DIFFDIFF WNBWNB

Bas% Bas% R R 0.1 0.1 % %
IMG% IMG% R R 9.2 9.2 % % FL FL FS FS
RBC RBC L 2.63

L 2.63 10^12/L10^12/L
HGB HGB L 75L 75 g/L g/L
HCT HCT L 23.4

L 23.4 % %
MCV MCV 88.9 88.9 fL fL
MCH MCH 28.4 28.4 pg pg
MCHC MCHC 320 320 g/L g/L

SS SS FL FL
RDW-CVRDW-CV H 19.0
H 19.0 % %
RDW-SDRDW-SD H 61.9
H 61.9 fL fL
PLT PLT R R 292 292 10^9/L 10^9/L AlarmAlarm

MPV MPV R R 12.0 12.0 fL fL
- Blasts?
- Blasts?
PDW PDW R R 16.9 16.9
- Abn-Lymph/blast?
Abn Lymph/blast?
PCT PCT R HR 0.352
H 0.352 % % - Immature
- Immature
Gran?Gran?
P-LCC P-LCC R HR 125
H 125 10^9/L 10^9/L - Atypical
- Atypical
Lymph?Lymph?
P-LCR P-LCR R R 42.8 42.8 % %
…… ……
NRBC# NRBC# 0.261 0.261 10^9/L 10^9/L
NRBC% NRBC% 2.00 2.00 /100WBC

/100WBC
WBC was
WBCnot
waslow,
notMon%
low, Mon%
increased,
increased,
moderate
moderate
anemia,
anemia,
normalnormal
PLT. PLT.
The presence
The presence
of grayish-white
of grayish-white
particles
particles
in theinDIFF
thescattergram
DIFF scattergram
was mainly
was mainly
due toduethetoextension
the extension
of theofNeu
thecluster
Neu cluster
towards
towards
the upper
the upper
left corner.
left corner.
DenseDense
particles
particles
in theinMon
theregion
Mon region
led toled
ill-defined
to ill-defined
boundaries
boundaries
between
between
Lym and
LymMon
and Mon
particle
particle
clusters,
clusters,
suggesting
suggesting
the possible
the possible
presence
presence
of immature
of immature
granulocytes,
granulocytes,
especially
especially
promyelocytes
promyelocytes
and blasts.
and blasts.
The The
PLT histogram
PLT histogram
showed showed
raisedraised
tail. Large
tail. Large
platelets
platelets
or interference
or interference
from red
from blood
red blood
cell fragments
cell fragments
and microcytes
and microcytes
shouldshould
be be
ruled ruled
out. out.
25 | 25 | HemaCase—Clinical
HemaCase—Clinical Case Booklet
Case Booklet
Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
Whitecells
White blood
Whitecells
blood cells 201
blood cells
201 100% 100%
Promyelocytes
Promyelocytes
L LSegmented
Segmented
neutrophils
neutrophils
39 39 19.4 19.4
Band neutrophils
L LLymphocytes
H H
Monocytes
Monocytes 31 31 15.4 15.4
! !Metamyelocytes
! !Myelocytes
Myelocytes 15 15 7.5 7.5
! !Promyelocytes
Promyelocytes 4 4 2.0 2.0
! !Blasts Blasts 40 40 19.8 19.8
ReactiveReactive
lymphocytes
lymphocytes
9 9 4.5 4.5
Non -white
Nonblood
-whitecells
blood cells
78 78 % % Myeloblasts
Myeloblasts
! !Nucleated
Nucleated
RBCs RBCs 8 8 4.0 4.0
Giant platelets
Giant platelets 9 9
Large platelets
Large platelets 7 7
SmudgeSmudge
cells cells 43 43 21.4 21.4
Platelets
Platelets
PLT estimate
Estimated
Estimation
Estimation
PlateletPlatelet
concentration
concentration
241*10^9/L
241*10^9/L
Automated
Automated
PlateletPlatelet
concentration
concentration
268*10^9/L
268*10^9/L
Manual Manual
Results
Results
fromfrom
manual
manual
re-classification
re-classification
Immature
Immature
granulocytes
granulocytes
accounted
accounted
for 16.9%,
for 16.9%,
of which
of which
promyelocytes
promyelocytes
accounted
accounted
for 3.4%,
for with
3.4%,large,
with round
large, round
or ovalorcell
oval cell
bodies;bodies;
nucleinuclei
were deviated
were deviated
to onetoside;
onechromatins
side; chromatins
were coarser
were coarser
than those
than those
of blasts;
of blasts;
nucleoli
nucleoli
were starting
were starting
to close,
to close,
and and
were less
wereprominent
less prominent
than those
than those
of blasts;
of blasts;
cytoplasm
cytoplasm
was blue,
wascontaining
blue, containing
varying
varying
numbersnumbers
of purple-red
of purple-red
granules
granules
with with
different
different
morphology
morphology
and uneven
and uneven
distribution.
distribution.
Myeloblasts
Myeloblasts
and promyelocytes
and promyelocytes
accounted
accounted
for 18.4%,
for 18.4%,
with large
with oval
largecell
oval cell
bodiesbodies
and blue
andcytoplasm
blue cytoplasm
without
without
granules;
granules;
chromatins
chromatins
were fine;
were2–3
fine;nucleoli
2–3 nucleoli
could could
be seen.be seen.
The PLT
Theestimate
PLT estimate
was consistent
was consistent
with CBC,
withand
CBC,giant
and platelets
giant platelets
were observed.
were observed.
Bone
Bone
marrow
marrow
cytology
cytology
examination
examination
ActiveActive
nucleated
nucleated
cell hyperplasia
cell hyperplasia
in bonein bone
marrow.
marrow.
Myeloids
Myeloids
accounted
accounted
for 54.5%
for 54.5%
and erythroids
and erythroids
for 4%,forwith
4%,M:E
withratio
M:E ratio
beingbeing
13.63:1.
13.63:1.
Myeloids:
Myeloids:
Promyelocytes
Promyelocytes
and cells
andincells
earlier
in earlier
stagesstages
were observed,
were observed,
with awith
higher
a higher
proportion
proportion
of metamyelocytes
of metamyelocytes and and
segmented
segmented
neutrophils.
neutrophils.
SomeSome
myeloids
myeloids
exhibited
exhibited
unbalanced
unbalanced
nucleusnucleus
and cytoplasm
and cytoplasm
development
development
as wellasaswell as
degranulation.
degranulation.
Erythroids:
Erythroids:
MainlyMainly
polychromatic
polychromatic
normoblasts
normoblasts
and orthochromatic
and orthochromatic
normoblasts,
normoblasts,
with low
withproportions
low proportions
of cellsofatcells
eachat each
developmental
developmental
stage.stage.
Erythroblast
Erythroblast
morphology
morphology
was generally
was generally
normal.normal.
Mature Mature
RBCs varied
RBCs varied
in sizes.
in sizes.
One megakaryocyte
One megakaryocyte and small
and small
platelet
platelet
clumpsclumps
were observed
were observed
on theonslide.
the slide.
Blasts Blasts
accounted
accounted
for 17%,
for with
17%,medium-sized
with medium-sizedcell bodies,
cell bodies,
fine chromatins,
fine chromatins,
and visible
and visible
nucleoli;
nucleoli;
cytoplasm
cytoplasm
was bluewasandblue and
the amount
the amount
was fair.
was fair.
The morphology
The morphology
was consistent
was consistent
with myelodysplastic
with myelodysplastic
syndrome
syndrome
with excess
with excess
blastsblasts
(MDS-EB-2).
(MDS-EB-2).
FurtherFurther
diagnosis
diagnosis
is is
recommended
recommended
by flow bycytometry
flow cytometry
analysis.
analysis.
CaseCase
analysis
analysis
Type Type
DysplasiaDysplasia
Cytopenia
Cytopenia
Ring sideroblasts
Ring sideroblasts
Blasts in Blasts
bone marrow
in bone and
marrow
peripheral
and peripheral
blood Conventional
blood Conventional
karyotyping
karyotyping
MDS with
MDSexcess
with excess
blastsblasts
(MDS-EB)
(MDS-EB)
MDS-EB1 MDS-EB1
0–3 lineages
0–3 lineages
1–3 lineages
1–3 lineages
Any ratio Any ratio
5%–9% in5%–9%
bone marrow
in boneormarrow
2%–4%orin2%–4% in
Any karyotype
Any karyotype
peripheralperipheral
blood, without
blood,Auer
without
bodies
Auer bodies
can becan
divided
be divided
into 2into
subtypes:
2 subtypes: 10%–19%10%–19%
in bone marrow
in boneormarrow
5%–19% or in
5%–19% in
MDS-EB2 MDS-EB2
0–3 lineages
0–3 lineages
1–3 lineages
1–3 lineages
Any ratio Any ratio Any karyotype
Any karyotype
peripheralperipheral
blood or with
blood
Auer
or with
bodies
Auer bodies
MDS-EBMDS-EB
has a higher
has a higher
risk ofrisk
AML oftransformation
AML transformation
compared
compared
with other
with other
subtypes,
subtypes,
and MDS-EB
and MDS-EB
with excess
with excess
blastsblasts
generally
generally
has a poorer
has a poorer
prognosis.
prognosis.
Treatment
Treatment
options
options
include
include
bone bone
marrow
marrow
transplantation
transplantation
or demethylation
or demethylation
therapy.
therapy.
However,
However,
in thisin this
case, the
case,patient
the patient
was elderly,
was elderly,
and interventions
and interventions
aimedaimed
at improving
at improving
individual
individual
disease
disease
resistance
resistance
and slowing
and slowing
dysplasia.
dysplasia.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 26 |
Case Booklet 26
09
Case 09
Multiple myeloma (MM)
The patient was a 64-year-old male who was admitted to the emergency room due to severe anemia and lumbar vertebral
fracture.
CBC results
Parameter Alarm Result Unit RBC PLT
WBC L 3.51 10^9/L
Neu# R L 0.86 10^9/L
Lym# R 1.58 10^9/L
Mon# R 1.06 10^9/L
Eos# L 0.01 10^9/L
Bas# 0.00 10^9/L
IMG# R 0.01 10^9/L 0 100 200 fL 0 10 20 30 fL
Neu% R L 24.4 %
Lym% R H 44.9 %
Mon% R H 30.2 %
Eos% L 0.4 % DIFF WNB
Bas% 0.1 %
FL FS
IMG% R 0.4 %
RBC L 1.22 10^12/L
HGB L 47 g/L
HCT L 13.8 %
MCV H 112.6 fL
MCH H 38.4 pg
MCHC 341 g/L SS FL
RDW-CV 15.6 %
PLT L 24 10^9/L
MPV 9.3 fL - Pancytopenia
PDW H 18.9 - Blasts?
- Abn Lymph/blast?
PCT L 0.022 %
- Atypical Lymph?
P-LCC L 5 10^9/L
……
P-LCR 21.1 %
NRBC# 0.000 10^9/L
NRBC% 0.00 /100WBC
Slightly decreased WBC, decreased Neu; severe anemia and MCV was not small; extremely low PLT.
Due to the decreased RBC/PLT, the area under the histogram was significantly reduced. Abnormal distribution of Lym and
Mon particle clusters was observed in the DIFF scattergram, with Lym particles extending towards the upper right and
Mon particles distributed in the high-fluorescence region, shifting to the right. Above Mon, some particles were identified
as abnormal lymphocytes and blasts. The scattergram of this patient was overall similar to that of lymphocytic leukemia.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
White
cells
blood cells
White blood
White
cells
blood cells
113 113100% 100% Plasma
Plasma
cells cells
L Segmented
L Segmented
neutrophils
neutrophils
17 17 15.0 15.0
Band neutrophils
Band neutrophils5 5 4.4 4.4
H Lymphocytes
H Lymphocytes 46 46 40.7 40.7
L Monocytes
Reactive lymphocytes
1 1 0.9 0.9
！ Plasma
！ cells
Plasma cells 42 42 37.2 37.2
Non-whiteNon-white
blood cells
blood
29cells 29 % %
Smudge cells
Smudge cells 17 17 15.0 15.0
Platelets Platelets
PLT estimate
Estimation
Estimation
result result
method method
12*10^9/L12*10^9/L
Manual Manual
Red bloodRed
cells
blood cells
Size Size Degree Degree
% %
Anisocytosis
Anisocytosis 0 0
Macrocytes
! Microcytes
! Microcytes 2+ 2+ 11.9 11.9
Color Color Degree Degree
% %
! Hypochromic
! Hypochromic
cells cells
3+ 3+ 44.1 44.1 Results
Results
fromfrom
manual
manual
re-classification
re-classification
Polychromasia
Shape Shape Degree Degree

% %
The classification
The classification
resultsresults
of Neutrophils
of Neutrophils
and lymphocytes
and lymphocytes
were consistent
were consistent
with with
! Poikilocytosis
! Schistocytes
the CBCtheresults.
CBC results.
Few Monocytes
Few Monocytes
and a and
largea number
large number
of plasma
of plasma
cells were
cells were
Echinocytes
Echinocytes 0 0 0.8 0.8 observed
observed
underunder
microscopy.
microscopy.
The nuclei
The nuclei
of the of
plasma
the plasma
cells were
cellsoften
were round
often round
and and
Elliptocytes
Elliptocytes 0 0 0.3 0.3 eccentric,
eccentric,
with chromatins
with chromatins
agglutinated
agglutinated
into large
into blocks
large blocks
and noandnucleolus
no nucleolus
! Ovalocytes
! Ovalocytes 2+ 2+ 11.8 11.8
visible,visible,
and the and
cytoplasm
the cytoplasm
was deep
was blue
deepand
blueappeared
and appeared
foamy.foamy.
Rouleaux
Rouleaux
RBCs RBCs
Stomatocytses
Stomatocytses 0 0 0.0 0.0
were also
wereobserved.
also observed.
Target cells
Teardrop cells
Teardrop cells 0 0 0.3 0.3
Other
Other
examinations
examinations CaseCase
analysis
analysis
Item Item ResultResult Reference
Reference
rangerange The patient
The patient
was diagnosed
was diagnosed
with multiple
with multiple
myeloma
myeloma
IgA-Kappa
IgA-Kappa
type. type.
Rheumatoid
Rheumatoid
factor factor <20 <20 0-20(IU/ml)
0-20(IU/ml)
Multiple
Multiple
myeloma myeloma
(MM) is(MM)
a malignant
is a malignant
disease disease
characterized
characterized
Anti-streptolysin
Anti-streptolysin
"O" "O"<25 <25 0-100(IU/ml)
0-100(IU/ml)
by clonal
by clonal
proliferation
proliferation
of plasma
of plasma
cells. Itcells.
is more
It is common
more common in in
C-reactive
C-reactive
protein protein 4.45 4.45 0-8(mg/L)
0-8(mg/L) middle-aged
middle-aged
and elderly
and elderly
population.
population.
With the With aging
the aging
of the of the
Immunoglobulin
Immunoglobulin
A A 41 41 0.7-4.0(g/L)
0.7-4.0(g/L)
Chinese
Chinese
population,
population,
the incidence
the incidence
of MMofis MM increasing.
is increasing.
Due Due
to theto
massive
the massive
secretionsecretion
and deposition
and depositionof monoclonal
of monoclonal
Immunoglobulin
Immunoglobulin
G G 4.76 4.76 7-16(g/L)
7-16(g/L)
antibodies
antibodies
on theon bone
the marrow
bone marrow stroma, stroma,
osteoclasts
osteoclasts
are are
Immunoglobulin
Immunoglobulin
M M 0.18 0.18 0.4-2.3(g/L)
0.4-2.3(g/L) activated,
activated,
leadingleading
to bone to disease
bone diseaseand hypercalcemia.
and hypercalcemia.
κ light chain
κ light chain 512 512 6.7-22.4(mg/L)
6.7-22.4(mg/L)
Moreover,
Moreover,
the malignant
the malignant
proliferation
proliferation
of plasmaof plasma
cells inhibits
cells inhibits
normalnormal
hematopoiesis,
hematopoiesis,
leading leading
to anemia.
to anemia.
The largeThe amount
large amount
λ light chain
λ light chain 13.4 13.4 8.3-27.0(mg/L)
8.3-27.0(mg/L)
of globulin
of globulin
also results
also results
in renalininsufficiency.
renal insufficiency.
Therefore,
Therefore,
the the
κ light chain/λ
κ light chain/λ light 38.209
light chain chain 38.209 0.31-1.56
0.31-1.56 acronym
acronym
CRAB, CRAB,
whichwhich
standsstands
for theforfirst
theletter
first of
letter
the of
four
the four
Immunophenotype
Immunophenotype IgA-Kappa
IgA-Kappa
lambda lambda
Negative
Negative
main symptoms,
main symptoms,is usedisasused
an alternative
as an alternative
name namefor MM, for MM,
electrophoresis
electrophoresis monoclonal
monoclonal
band band
commonly
commonly
knownknownas "crabas disease".
"crab disease".
Total protein
Total protein 99.5 99.5 65-85(g/L)
65-85(g/L)
Patients
Patients
with MMwithare
MM prone
are prone
to rouleaux
to rouleaux
formation
formation
of RBCsof RBCs
AlbuminAlbumin 28 28 40-55(g/L)
40-55(g/L)
due todue
thetoincreased
the increased
fibrinogen
fibrinogen
and globulin
and globulin
in the in
blood,
the blood,
GlobulinGlobulin 71.5 71.5 20-40(g/L)
20-40(g/L) whichwhich
shieldshield
the surface
the surface
potential
potential
of RBCs ofand
RBCsweaken
and weaken
the the
A/G ratioA/G ratio 0.39 0.39 1.2-2.4 1.2-2.4
mutualmutual
repulsion
repulsion
between between
RBCs. IfRBCs.
rouleaux
If rouleaux
RBCs are
RBCs are
observed,
observed,
attention
attention
must be mustpaid
betopaid
abnormal
to abnormal
lymphocyte
lymphocyte
Blood urea
Blood
nitrogen
urea nitrogen17.3 17.3 2.8-7.14mmol/L
2.8-7.14mmol/L
screening
screening
and protein
and protein
electrophoresis
electrophoresis
assay toassay
avoid
to avoid
the the
Creatinine
Creatinine 174.78 174.78 40-135μmol/L
40-135μmol/L missedmissed
diagnosis
diagnosis
of MM.of MM.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 28 |
Case Booklet 28
Case 10
B-cell lymphoblastic leukemia (B-ALL) 10
The patient was a 7-year-old male who was admitted to the hospital due to intermittent back pain for more than two
months, along with chest pain and pain in both lower limbs for over a month. Abdominal ultrasound showed splenomegaly.
CBC results
RBC PLT
WBC & 6.09 10^9/L
Neu# & R L 0.88 10^9/L
Lym# & R 3.50 10^9/L
Mon# R L 0.00 10^9/L
Eos# H 1.71 10^9/L
Bas# 0.00 10^9/L
IMG# R 0.09 10^9/L
0 100 200 fL 0 10 20 30 fL
Neu% & R L 14.5 %
Lym% & R 57.3 %
Mon% R L 0.1 %
Eos% H 28.1 % DIFF WNB
Bas% 0.0 %
FL FS
IMG% R 1.5 %
RBC 3.86 10^12/L
HGB L 107 g/L
HCT L 32.6 %
MCV 84.4 fL
MCH 27.7 pg
MCHC 328 g/L
SS FL
RDW-CV 15.3 %
RDW-SD 45.5 fL
PLT L 57 10^9/L
Alarm
MPV 8.0 fL
PDW 16.0
- Blasts?
- Abn Lymph/blast?
PCT L 0.046 %
- Immature Gran?
P-LCC L 11 10^9/L ……
P-LCR 18.8 %
NRBC# 0.039 10^9/L
NRBC% 0.64 /100WBC
WBC was not low; Neu and Mon decreased; Eos increased; moderate anemia; PLT decreased.
In the PLT histogram, the tail of the plot was elevated and in a serration pattern; interference from large platelets, platelet
aggregation, or RBC fragments should be ruled out by microscopy. In the DIFF scattergram, the Eos particles was
significantly dense and Lym particle cluster extended to the high-fluorescence region. Abnormal cells were suspected.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
Whitecells
blood cells
White blood
Whitecells
blood cells 110 110 100% 100%
Blasts
Blasts
L Segmented
L Segmented
neutrophils
Band neutrophils
Lymphocytes
L Monocytes
H Eosinophils
H Eosinophils 18 18 16.4 16.4
Metamyelocytes
！ Myelocytes
！ Myelocytes 3 3 2.7 2.7
！ Blasts
！ Blasts 24 24 21.8 21.8
！ Abnormal
！ Abnormal
lymphocyte
lymphocyte 2 2 1.8 1.8
Non-white
Non-white
blood cells
SmudgeSmudge
Platelets
Platelets
PLT estimate
Estimated
Estimation
Estimation
58*10^9/L
Automated
Automated
51*10^9/L
Manual Manual
Red blood
Redcells
blood cells
Anisocytosis
Anisocytosis 0 0
Macrocytes
Macrocytes 0 0 0.8 0.8 Results
Results
fromfrom
manual
manual
re-classification
re-classification
! !
Microcytes
Microcytes 3+ 3+ 21.3 21.3
! Hypochromic
! Hypochromic
cells cells 3+ 3+ 82.1 82.1
Immature
Immature
granulocytes
granulocytes
accounted
accounted
for 4.5%;
for 4.5%;
myeloblasts
myeloblasts
and and
Polychromasia
Polychromasia 0 0 0.3 0.3 promyelocytes
promyelocytesaccounted
accounted
for 23.6%.
for 23.6%.
Myeloblasts
Myeloblasts
and and
Shape Shape Degree Degree % % promyelocytes
promyelocyteshad round
had round
or oval
orcell
ovalbodies,
cell bodies,
roundround
or oval
or oval
! Poikilocytosis
! Poikilocytosis 3+ 3+ nuclei,nuclei,
and fine
andchromatins;
fine chromatins;
cuts marks
cuts marks
were were
visible;
visible;
! Schistocytes
! Schistocytes 3+ 3+ 2.9 2.9 cytoplasm
cytoplasm
was scant
was scant
and inand
blue
in color.
blue color.
The PLT
Theestimate
PLT estimate
was was
Echinocytes
Echinocytes 0 0 0.3 0.3 consistent
consistent
with the
withCBC
theresult.
CBC result.
Schistocytes
Schistocytes
were were
observed.
observed.
Elliptocytes
! Ovalocytes
! Ovalocytes 2+ 2+ 13.7 13.7
Stomatocytes
! Target
! cells
Target cells 2+ 2+ 5.1 5.1
TeardropTeardrop
Other
Other
examinations
examinations
Item Item ResultResult
Abnormal
Abnormal
naive B naive
cells accounted
B cells accounted
for 97.60%
for 97.60%
of nucleated
of nucleated
cells, expressing
cells, expressing
CD19, CD22,
CD19,cCD79a,
CD22, cCD79a,
CD34, CD10,
CD34,cTdT,
CD10,CD58,
cTdT,and
CD58,
notand
expressing
not expressing
Flow cytometry
Flow cytometry CD33, CD15,
CD33,CD13,
CD15,CD38,
CD13,CD81,
CD38,CD20,
CD81,CD7,
CD20,
cMPO,
CD7,cCD3,
cMPO,CD117,
cCD3, CD56,
CD117,cIgM,
CD56,
orcIgM,
CD66c.
or CD66c.
Immunophenotyping
Immunophenotyping
suggested
suggested
B cell acute
B celllymphoblastic
acute lymphoblastic
leukemia,
leukemia,
with high
with
probability
high probability
of Common
of Common
B-ALL B-ALL
Lymphocytes
Lymphocytes
accounted
accounted
for 97.5%,
forof
97.5%,
whichofmyeloblasts
which myeloblasts
and promyelocytes
and promyelocytes
accounted
accounted
for 97%.for 97%.
Bone marrow cytologycytologyCytochemical
Bone marrow Cytochemical
stainingstaining
results: POX
results:
(-), POX
AS-DCE
(-), AS-DCE
(-), a-NAE
(-),(+),
a-NAE
a-NAF
(+),(no
a-NAF
inhibition),
(no inhibition),
a-NBE (-),
a-NBE
PAS (+).
(-), PAS (+).
Suggested
Suggested
diagnosis:
diagnosis:
ALL ALL
Fusion gene
Fusion gene Negative,
Negative,
no largeno
deletion
large deletion
of IKZF1ofgene
IKZF1
was
gene
observed,
was observed,
and ph-like
and gene
ph-like
rearrangement
gene rearrangement
was negative.
was negative.
Chromosomal
Chromosomal
examination
examination
Chromosome
Chromosome
karyotyping
karyotyping
showedshowed
46, XY(3)46, XY(3)
CaseCase
analysis
analysis
This patient
This patient
was diagnosed
was diagnosed
with B-cell
with B-cell
acuteacute
lymphoblastic
lymphoblastic
leukemia
leukemia
(B-ALL).
(B-ALL).
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 30 |
Case Booklet 30
CaseCase
11 11
B-cell
B-cell
lymphoblastic
lymphoblastic
leukemia
leukemia
(B-ALL)
(B-ALL)
Clinical
Clinical
information
information
1111
The patient
The patient
was a was
48-year-old
a 48-year-old
femalefemale
who experienced
who experienced
with flatulent
with flatulent
dyspnea
dyspnea
and low-grade
and low-grade
fever with
feverno
with
obvious
no obvious
causecause
more more
than 10
than
days
10ago.
daysTheago.patient
The patient
was alert
wasand
alertoriented
and oriented
with no
with
skin
noorskin
mucous
or mucous
membrane
membrane
bleeding.
bleeding.
No enlargement
No enlargement
of superficial
of superficial
lymphlymph
nodes,nodes,
liver, or
liver,
spleen
or spleen
was observed.
was observed.
CBCCBC
results
results
Parameter
ParameterAlarmAlarm ResultResult Unit Unit RBCRBC PLT PLT
WBC WBC & & H 83.29
H 83.29 10^9/L
10^9/L
Neu# Neu# & R& LR 0.98
L 0.98 10^9/L
10^9/L
Lym# Lym# & R& HR 81.62
H 81.62 10^9/L
10^9/L
Mon#Mon# R R 0.66 0.66 10^9/L
10^9/L
Eos# Eos# R LR 0.01
L 0.01 10^9/L
10^9/L
Bas# Bas# R R 0.02 0.02 10^9/L
10^9/L
0 0 100 01002000 200 fL fL 0 10
0 10
20 20
30 30fL fL
IMG# IMG# R R 0.11 0.11 10^9/L
10^9/L
Neu%Neu% & R& LR 1.2
L 1.2 % %
Lym%Lym% & R& HR 98.0
H 98.0 % %
Mon%Mon% R LR 0.8
L 0.8 % %
DIFFDIFF WNBWNB
Eos% Eos% R LR 0.0
L 0.0 % % FL FL FS FS
Bas% Bas% R R 0.0 0.0 % %

IMG%IMG% R R 0.1 0.1 % %
RBC RBC L 2.23
L 2.23 10^12/L
10^12/L
HGB HGB L 65
L 65 g/L g/L
HCT HCT L 19.5
L 19.5 % %
MCV MCV 87.8 87.8 fL fL SS SS FL FL
MCH MCH 29.1 29.1 pg pg

MCHCMCHC 331 331 g/L g/L Alarm
Alarm
RDW-CV
RDW-CV 13.6 13.6 % %
- Abn.- WBC
Abn. scattergram
WBC scattergram - Neutropenia
- Neutropenia
RDW-SD
RDW-SD 43.5 43.5 fL fL
- Abn-Lymph/blast?
Abn Lymph/blast? - Leukocytosis
- Leukocytosis
PLT PLT L 15
L 15 10^9/L
10^9/L - Immature
- Immature
Gran?Gran? - Anemia
- Anemia
MPV MPV 9.0 9.0 fL fL - Lymphocytosis
- Lymphocytosis - Thrombocytopenia
- Thrombocytopenia
PDW PDW 17.0 17.0
PCT PCT L 0.013
L 0.013 % %
P-LCCP-LCC L 3L 3 10^9/L
10^9/L WBC increased,
WBC increased,
predominantly
predominantly
Lym; moderate
Lym; moderate
anemia;
anemia;
P-LCRP-LCR 23.3 23.3 % % extremely
extremely
low PLT.
low PLT.
NRBC#NRBC# 0.036 0.036 10^9/L

10^9/L In theIn
DIFF
thescattergram,
DIFF scattergram,
Lym particles
Lym particles
extended
extended
towards
towards
the the
high-fluorescence
high-fluorescence
region,region,
appearing
appearing
as comet-shaped
as comet-shaped
NRBC%
NRBC% 0.04 0.04 /100WBC
/100WBC
clusters;
clusters;
neu particles
neu particles
were significantly
were significantly
decreased.
decreased.
31 | 31 | HemaCase—Clinical
HemaCase—Clinical Case Booklet
Case Booklet
Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
Whitecells
blood cells
Myeloblasts
Myeloblasts
and promyelocytes
and promyelocytes
White blood
White
cells
blood cells 201 201 100% 100%
L Segmented
L Segmented
neutrophils
Band neutrophils
Lymphocytes
！ Blasts
！ Blasts 150 150 74.6 74.6
Non-white
Non-white
blood cells
Nucleated
Nucleated
RBCs RBCs 1 1 0.5 0.5
Smudge Smudge
cells cells 43 43 21.4 21.4
Platelets
Platelets
PLT estimate
Estimated
Estimation
Estimation
55*10^9/L
Automated
Automated
76*10^9/L
Manual Manual
Red blood
Redcells
blood cells
！ Anisocytosis
！ Anisocytosis 3+ 3+
Macrocytes
! Microcytes
! Microcytes 3+ 3+ 50.2 50.2

! Hypochromic
! Hypochromic
cells cells 3+ 3+ 71.3 71.3
Polychromasia
! Poikilocytosis
! Schistocytes
Echinocytes
Elliptocytes
Ovalocytes
Stomatocytes
Target cells
TeardropTeardrop
Results
Results
fromfrom
manual
manual
re-classification
re-classification
BlastsBlasts
accounted
accounted
for 74.6%,
for 74.6%,
with variable
with variable
cell sizes,
cell sizes,
scant scant
cytoplasm,
cytoplasm,
verrucous
verrucous
protrusions,
protrusions,
roundround
or ovalornuclei,
oval nuclei,
fine fine
chromatins,
chromatins,
and visible
and visible
nucleoli.
nucleoli.
Other
Other
examinations
examinations
Item Item Result Result
Bone marrow
Bone marrow
cytologycytology Abnormal
Abnormal
lymphocyte
lymphocyte
proliferation,
proliferation,
prolymohocytes
prolymohocytes
accounted
accounted
for 93.5%,
for and
93.5%,
mature
and mature
lymphocytes
lymphocytes
accounted
accounted
for 5.5%.for 5.5%.
Suggested
Suggested
diagnosis:
diagnosis:
ALL ALL
Flow cytometry
Flow cytometry Abnormal
Abnormal
B lymphoblasts
B lymphoblasts
accounted
accounted
for 92%for
of nucleated
92% of nucleated
cells (Common
cells (Common
B-ALL) B-ALL)
Gene Gene BCR-ABLBCR-ABL
(p190) positive
(p190) positive
Chromosomal
Chromosomal examination46,XX,t(9;22)(q34;q11.2)
examination 46,XX,t(9;22)(q34;q11.2)
Case
Case
analysis
analysis
The diagnosis
The diagnosis
of thisofcase
thiswas
caseB-ALL
was B-ALL
with t(9;22)(q34;q11.2);
with t(9;22)(q34;q11.2);
BCR-ABL1.
BCR-ABL1.
This isThis
a subtype
is a subtype
with poor
with prognosis,
poor prognosis,
but the
but
prognosis
the prognosis
of Ph+ofALL
Ph+has
ALLgradually
has gradually
improved
improved
in recent
in recent
years with
yearsthe
withuse
theofuse
tyrosine
of tyrosine
kinasekinase
inhibitors.
inhibitors.
The DIFF
Thescattergram
DIFF scattergram
of theoftwotheB-ALL
two B-ALL
cases cases
are very
aresimilar,
very similar,
with Lymwithparticles
Lym particles
formingforming
comet-shaped
comet-shaped
clusters
clusters
extending
extending
towards
towards
the upper
the upper
right, and
right,the
and
left
theedge
left of
edge
theof
clusters
the clusters
not showing
not showing
the rightward
the rightward
concaveconcave
observed
observed
in thein
AML
thecase.
AML case.
Therefore,
Therefore,
when when
similarsimilar
scattergram
scattergram
are seen
areinseen
practice,
in practice,
it is important
it is important
to watch
to watch
for abnormal
for abnormal
lymphocytes.
lymphocytes.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 32 |
Case Booklet 32
12
Case 12
Chronic Lymophocytic leukemia (CLL)
The patient was a 64-year-old female who had been diagnosed with chronic lymphocytic leukemia more than 2 years ago.
Considering the patient had no indication for treatment, CBC and blood smear examination were regularly conducted at the
Department of Hematology. The results showed fluctuations in WBCs ranging from 78–160 × 10^9/L and lymphocytes ranging
from 75–154 × 10^9/L.
CBC results
RBC PLT
WBC H 131.45 10^9/L
Neu# R 4.18 10^9/L
Lym# R H 125.25 10^9/L
Mon# R H 1.94 10^9/L
Eos# R 0.07 10^9/L
Bas# R 0.01 10^9/L
IMG# R 0.10 10^9/L
Neu% R L 3.2 % 0 100 200 fL 0 10 20 30 fL
Lym% R H 95.2 %
Mon% R L 1.5 %
Eos% R L 0.1 %
Bas% R 0.0 % DIFF WNB
IMG% R 0.1 %
FL FS
RBC 4.89 10^12/L
HGB 131 g/L
HCT L 39.9 %
MCV 81.7 fL
MCH L 26.7 pg
MCHC 327 g/L
RDW-CV H 18.1 % SS FL
RDW-SD 53.4 fL
PLT R 134 10^9/L
MPV R 9.6 fL Alarm
PDW R 15.7
- Abn. WBC scattergram
PCT R 0.129 %
- Abn Lymph/blast?
P-LCC R 34 10^9/L
- Immature Gran?
P-LCR R 25.6 %
- Monocytosis
NRBC# 0.000 10^9/L
……
NRBC% 0.00 /100WBC
WBC increased, predominantly Lymphocytes, and Monocytes also increased; RBC and PLT were roughly normal.
In the DIFF scattergram, the Lym region was significantly dense and some particles extended towards the high-fluorescence
region. These particles were classified as Mon by the software. Blood smear re-check was required to confirm whether they
were abnormal cells.

Peripheral blood morphology examination
White blood cells
Lymphocytes
H Lymphocytes 287 95.7
L Monocytes 2 0.7
！ Blasts 4 1.3
Large platelets 7
Platelets
PLT estimate Estimated Estimation
result method
Platelet concentration 183*10^9/L Manual
Red blood cells
Size Degree %
Anisocytosis 0
Macrocytes 0 0.5
! Microcytes 2+ 11.6
Color Degree %
! Hypochromic cells 3+ 20.1
Polychromasia 0 0.1
Shape Degree %
! Poikilocytosis 1+ Results from manual re-classification
! Schistocytes 1+ 0.9
Echinocytes 0 2.1
Elliptocoytes 0 4.0 Mature lymphocytes accounted for 97%, with small round cell
Ovalocytes 0 15.6 bodies and scant cytoplasm; the nuclei were round with
Stomatocytes 0 0.0
agglutinated chromatins.
Target cells 0 0.0
Teardrop cells 0 0.4
Case analysis
Chronic lymphocytic leukemia (CLL) is a mature B lymphocyte clonal proliferative tumor. Patients have monoclonal B
lymphocytes ≥ 5 × 10^9/L in peripheral blood, and leukemic cell morphology shows mature-appearing small lymphocytes,
with occasional naive lymphocytes and a small number of immature or atypical lymphocytes. Neutrophil percentage is
decreased, and thrombocytopenia and/or anemia may occur as the disease progresses. Smudge cells are easily seen in
peripheral blood.
The course of the disease is slow, and treatment is usually not necessary. Follow-up should be conducted every 2–6 months.
However, treatment can begin if any of the following conditions occur:
1. Evidence of progressive bone marrow failure: manifested as progressive reduction in hemoglobin and/or platelets, with hemoglobin less than 100
g/L and platelets less than 100 × 10^9/L.
2. Massive splenomegaly (e.g., > 6 cm below left costal margin) or progressive or symptomatic splenomegaly.
3. Massive lymphodenopathy (e.g., longest diameter > 10 cm) or progressive or symptomatic lymphodenopathy.
4. Naive lymphocytes ≥ 30 × 10^9/L, with progressive lymphocytosis, e.g., an increase of 50% within 2 months, or lymphocyte doubling time (LDT)
< 6 months. When the naive lymphocytes are < 30 × 10^9/L, LDT cannot be used as the only treatment indication, and other conditions that can
cause lymphocytosis, such as infection or steroid use, should be ruled out.
5. Autoimmune hemolytic anemia and/or thrombocytopenia that do not respond well to corticosteroids or other standard of care.
6. Symptomatic or functionally impairing extranodal lesions (skin, kidney, lung, spine, etc.), especially when symptoms cannot be resolved with
symptomatic treatment.
7. Presence of at least one of the following disease-related symptoms.
1 Weight loss of ≥ 10% for no apparent reason in the past 6 months.
2 Severe fatigue (e.g., ECOG performance status ≥ 2; unable to carry out daily activities).
3 Body temperature > 38.0°C with no evidence of infection, lasting for more than 2 weeks.
4 Night sweats with no evidence of infection, lasting for more than 1 month.

Case 13
Mantle cell lymphoma (MCL) 13
The patient was a 60-year-old male who had been experiencing left knee joint pain and limited mobility for over 2 years, which
worsened over the past 3 months. There was mild deformity in the left knee joint, and the patient was admitted to the hospital
for "left knee osteoarthritis".
CBC results
WBC H 15.06 10^9/L
Neu# R L 1.94 10^9/L
Lym# R H 12.77 10^9/L
Mon# R 0.29 10^9/L
Eos# 0.04 10^9/L
Bas# 0.02 10^9/L
IMG# R 0.00 10^9/L
0 100 200 fL 0 10 20 30 fL
Neu% R L 12.9 %
Lym% R H 84.9 %
Mon% R L 1.9 %
Eos% L 0.2 %
DIFF WNB
Bas% 0.1 %
IMG% R 0.0 % FL FS
RBC 5.17 10^12/L
HGB 159 g/L
HCT 46.5 %
MCV 89.9 fL
MCH 30.8 pg
MCHC 342 g/L
RDW-CV 12.8 % SS FL
RDW-SD 44.6 fL
PLT 125 10^9/L
Alarm
MPV 9.4 fL
PDW 15.9 - Abn. WBC scattergram
PCT 0.117 % - Abn Lymph/blast?
P-LCC L 26 10^9/L - Lymphocytosis
P-LCR 21.2 %
NRBC# 0.000 10^9/L
NRBC% 0.00 /100WBC
WBC increased, predominantly Lym; Neu decreased; RBC and PLT were normal
In the DIFF scattergram, Lym region was significantly dense, with a roughly normal overall distribution. Based on the
WNB scattergram, abnormal cell alarm was given by nucleus-plasma double-check technology.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
White
cells
blood cells
White blood
White
cells
blood cells 150 150 100% 100%
Abnormal
Abnormal
lymphocytes
lymphocytes
L Segmented
L Segmented
neutrophils
neutrophils8 8 5.3 5.3
Band neutrophils
H Lymphocytes
H Lymphocytes 109 109 72.7 72.7
L Monocytes
Eosinophils
！ Blasts
！ Blasts 10 10 6.7 6.7
Reactive lymphocytes 2 2 1.3 1.3
！ Abnormal
！ Abnormal
lymphocyte
lymphocyte 14 14 9.3 9.3
Non-white
Non-white
blood cells
blood cells14 14 % %
Large platelets
Large platelets 1 1
Smudge cells
Platelets Platelets
PLT estimate
Estimated
Estimation
Estimation
128*10^9/L Automated
143*10^9/L
Manual Manual
Red blood
Red
cells
blood cells
% %
Anisocytosis
Anisocytosis 0 0
Macrocytes
Microcytes
% %
Hypochromic
Hypochromic
Polychromasia
Polychromasia 0 0 0.1 0.1 Results
Results
from from
manual
manual
re-classification
re-classification
% %
Poikilocytosis
Poikilocytosis 0 0
Schistocytes
Lymphocytes
Lymphocytes
accounted
accounted
for 82%forand
82%abnormal
and abnormal
lymphocytes
lymphocytes
Echinocytes
Echinocytes 0 0 0.2 0.2 accounted
accounted
for 8%,forwith
8%,blue
withand
blueclear
andcytoplasm,
clear cytoplasm,
fine chromatins,
fine chromatins,
Elliptocytes
Elliptocytes 0 0 0.0 0.0 and visible
and visible
nucleoli.
nucleoli.
Ovalocytes
Stomatocytes
Target cells
Teardrop Teardrop
Other
Other
examinations
examinations
Item Item Result
Result
Bone marrow
Bone marrow
cytology
cytology The lymphocyte
The lymphocyte
percentage
percentage
increased,
increased,
with some
withirregular
some irregular
morphology,
morphology,
suggesting
suggesting
lymphoproliferative
lymphoproliferative
disorders
disorders
(LPD). (LPD).
Multiple
Multiple
clustersclusters
of CD3 of(+),CD3
multiple
(+), multiple
foci of CD20
foci of(+),
CD20multiple
(+), multiple
foci of CD79A
foci of CD79A
(+), multiple
(+), multiple
foci of CD5
foci of
(+),CD5
CD23
(+),(-),
CD23CD10
(-), CD10
Immunohistochemistry
Immunohistochemistrylymphocytes
lymphocytes
(-), few (-),
cyclinD1
few cyclinD1
(+), ki-67
(+),(15%+)
ki-67 (15%+)
Consistent
Consistent
with those
withof those
smallofBsmall
cell lymphoma
B cell lymphoma
(tumor(tumor
cells accounted
cells accounted
for approximately
for approximately
40%) 40%)
Flow cytometry
Flow cytometry CD5 + CD10
CD5 ++CD10
B lymphocytes
+ B lymphocytes
accounted
accounted
for 62.48%,
for 62.48%,
MCL? MCL?
Chromosomal
Chromosomal
examination
examination
46,XY,t(11;14)(q23;q32),
46,XY,t(11;14)(q23;q32),
add(14)(p11.2)[14]/46,XY[6]
add(14)(p11.2)[14]/46,XY[6]
CaseCase
analysis
analysis
MantleMantle
cell lymphoma
cell lymphoma
(MCL)(MCL)
is a small-to-medium
is a small-to-medium sized, sized,
monomorphic,
monomorphic,
mature mature
B-cell B-cell
tumortumor
with specific
with specific
immunophenotype
immunophenotype
and reproducible
and reproduciblegeneticgenetic
abnormalities.
abnormalities.
CD5 and
CD5SOX11and SOX11
are typically
are typically
expressed,
expressed,
and over
and95%
overof95%
patients
of patients
have CCND1
have CCND1
gene gene
rearrangement
rearrangement
(t(11:14)(q13;q32)
(t(11:14)(q13;q32)
abnormality),
abnormality),
resultingresulting
in highinnuclear
high nuclear
expression
expression
of Cyclin
of Cyclin
D1 protein.
D1 protein.
MCL mainly
MCL mainly
affectsaffects
elderlyelderly
men and menoften
and often
involves
involves
extranodal
extranodal
sites. Itsites.
has It
both
has the
bothcharacteristics
the characteristics
of rapid
of progression
rapid progression
of aggressive
of aggressive
lymphoma
lymphoma
and incurability
and incurability
of indolent
of indolent
lymphoma.
lymphoma.
The survival
The survival
time with
timemulti-drug
with multi-drug
combination
combination
chemotherapy
chemotherapy
is about
is about
3–5 years,
3–5 years,
and and
it currently
it currently
belongsbelongs
to incurable
to incurable
NHL. NHL.
The clinical
The clinical
manifestations
manifestations
of MCLofare
MCLnonspecific,
are nonspecific,
so theso
diagnosis
the diagnosis
and prognosis
and prognosis
evaluation
evaluation
at theat
initial
the initial
visit are
visit
critical.
are critical.
Pathological
Pathological
diagnosis
diagnosis
is the is
only
themeans
only means
to confirm
to confirm
the diagnosis
the diagnosis
of MCL.
of MCL.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 36 |
Case Booklet 36
14
Case 14
May-Hegglin anomaly
The patient was a 31-year-old female who was admitted in November due to "38 + 5 weeks of pregnancy with ultrasound
indicating oligohydramnios".
CBC results
Parameter Alarm
BC-6800Plus_2 BC-6800Plus_1
8:05 2022/10/26 8:09 2022/10/26
Unit RBC PLT
WBC 9.60 9.16 10^9/L
Neu# H 7.80 10^9/L
Lym# 1.24 10^9/L
Mon# 0.47 10^9/L
Eos# 0.07 10^9/L
Bas# 0.02 10^9/L
0
IMG# 0.09 10^9/L 0 100 200 fL 0 10 20 30 fL
Neu% H 81.2 %
Lym% L 13.0 %
Mon% 4.9 %
Eos% 0.7 % DIFF
FL
WNB
Bas% 0.2 %
FS
IMG% 0.9 %
RBC 3.87 3.96 10^12/L
HGB 123 122 g/L
HCT L 35.5 36.5 %
MCV 91.9 92.1 fL
MCH 31.8 30.9 pg
MCHC 346 335 g/L
RDW-CV 12.9 13.0 % SS FL
RDW-SD 45.9 44.3 fL
PLT R L 31 60 10^9/L
Alarm
MPV R H 15.5 15.9 fL
PDW R 16.6 17.1
PCT R L 0.047 0.056 %
- PLT Clump?
P-LCC R L 20 38 10^9/L - PLT Histogram Abn.
P-LCR R H 64.0 62.8 % - Thrombocytopenia
NRBC# 0.000 10^9/L
NRBC% 0.00 /100WBC
WBC and RBC were roughly normal; low PLT.

Low PLT triggered a re-test rule. Upon re-test, PLT-O was found to be 60 × 10^9/L. It was speculated that PLT-I was falsely
low due to interference from large platelets or platelet aggregation.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
White blood
Whitecells
blood cells
White blood
Whitecells
blood cells 150 150 100% 100%
Neutrophils
Neutrophils
H Segmented
H Segmented
neutrophils
neutrophils
133 133 88.6 88.6
Band neutrophils
L Lymphocytes
L Monocytes
Eosinophils
Metamyelocytes
ReactiveReactive
lymphocytes
lymphocytes
2 2 1.3 1.3
Non-white
Non-white
blood cells
blood cells
97 97 % %
Giant platelets
Giant platelets 24 24
Large platelets
Large platelets 65 65
SmudgeSmudge
PlateletsPlatelets
PLT estimate
Estimated
Estimation
Estimation
result resultmethodmethod
71*10^9/L
71*10^9/L
Manual Manual
Red blood
Redcells
blood cells
% %
Anisocytosis
Anisocytosis 0 0
Macrocytes
Microcytes
% %
！ Hypochromic
！ Hypochromic
cells cells 2+ 2+ 14.7 14.7 Eosinophil
Eosinophil GiantGiant
platelets
platelets
Polychromasia
% %
Poikilocytosis
Poikilocytosis 0 0
Schistocytes
Echinocytes
Elliptocytes
Ovalocytes
Stomatocytes
Target cells
TeardropTeardrop
Results
Results
fromfrom
manual
manual
re-classification
re-classification
The classification
The classification
resultsresults
were consistent
were consistent
with the
with
CBC
theresults.
CBC results.
Blue, cloudy
Blue, cloudy
plaquesplaques
resembling
resembling
DohleDohle
bodies,bodies,
irregular
irregular
in shape
in shape
and large
and inlarge
size,inwere
size,observed
were observed
in the in
cytoplasm
the cytoplasm
of neutrophils
of neutrophils
as wellasaswell
eosinophils
as eosinophils
at all stages.
at all stages.
May-Hegglin
May-Hegglin
anomaly
anomaly
was suspected.
was suspected.
Additionally,
Additionally,
giant and
giantlarge
and platelets
large platelets
were observed
were observed
in 59/100
in 59/100
WBCs,WBCs,
and the
and
PLTthe PLT
estimate
estimate
was consistent
was consistent
with the
with
PLT-O
the PLT-O
result.result.
CaseCase
analysis
analysis
The patient
The patient
presented
presented
with thrombocytopenia,
with thrombocytopenia,
giant platelets,
giant platelets,
and neutrophil
and neutrophil
inclusions,
inclusions,
whichwhich
were consistent
were consistent
with the
with the
manifestations
manifestations
of May-Hegglin
of May-Hegglin
anomaly.
anomaly.
Subsequent
Subsequent
genetic
genetic
testingtesting
confirmed
confirmed
the presence
the presence
of a heterozygous
of a heterozygous
MYH9MYH9
mutation
mutation
locatedlocated
at 22q12.3,
at 22q12.3,
AD. AD.
May-Hegglin
May-Hegglin
anomalyanomaly
is a type
is aoftype
MYH9-related
of MYH9-related
disorder,
disorder,
whichwhich
is a rare
is aautosomal
rare autosomal
dominant
dominant
genetic
genetic
disorder.
disorder.
DespiteDespite
a a
decrease
decrease
in platelet
in platelet
count,count,
the totaltheplatelet
total platelet
volume volume
in the in
blood
the blood
is not issignificantly
not significantly
reducedreduced
due todue
an increase
to an increase
in platelet
in platelet
size. size.
Platelet
Platelet
function
function
remainsremains
mostlymostly
normal,
normal,
and bleeding
and bleeding
tendencies
tendencies
are mild.arePatients
mild. Patients
are usually
are usually
diagnosed
diagnosed
in adulthood.
in adulthood.
Due toDue
significant
to significant
thrombocytopenia,
thrombocytopenia,
most patients
most patients
are misdiagnosed
are misdiagnosed
with ITP
with
at initial
ITP at diagnosis,
initial diagnosis,
and underwent
and underwent
unnecessary
unnecessary
hormone
hormone
therapy
therapy
or splenectomy.
or splenectomy.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 38 |
Case Booklet 38
Case 15
Pelger–Huët anomaly 15
The patient was a 76-year-old female with poorly controlled type 2 diabetes who visited the Department of
Endocrinology of the hospital.
CBC results

WBC L 1.72 10^9/L
Neu# L 1.28 10^9/L
Lym# L 0.37 10^9/L
Mon# L 0.06 10^9/L
Eos# L 0.01 10^9/L
0.00 0
Bas# 10^9/L
0 100 200 fL 0 10 20 30 fL
IMG# 0.00 10^9/L
Neu% H 74.6 %
Lym% 21.4 %
Mon% 3.6 %
DIFF WNB
Eos% L 0.3 % FL FS
Bas% 0.1 %
IMG% 0.1 %
RBC L 2.70 10^12/L
HGB L 83 g/L
HCT L 24.4 %
MCV 90.3 fL SS FL
MCH 30.7 pg
MCHC 340 g/L Alarm

RDW-CV 13.4 %
- Pancytopenia
RDW-SD 46.0 fL
- Lymphopenia
PLT L 47 10^9/L
- Leukocytopenia
MPV 10.1 fL - Anemia
PDW 16.3 - Thrombocytopenia
PCT L 0.047 %
P-LCC L 12 10^9/L
P-LCR 26.4 %
NRBC# 0.000 10^9/L Pancytopenia without abnormal cell alarm.

NRBC% 0.00 /100WBC No abnormality in histograms or scattergrams.

Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
WhiteWhite
bloodblood
cells cells P-H anomaly
P-H anomaly
WhiteWhite
bloodblood
cells cells 200 200 100% 100%
L LSegmented
Segmented
neutrophils
！ Band neutrophils
！ Band neutrophils 84 84 42.0 42.0
Lymphocytes
L LMonocytes
Monocytes 4 4 2.0 2.0
Eosinophils
Metamyelocytes
Non-white
Non-white
bloodblood
cells cells 27 27 % %
Giant platelets
Giant platelets 1 1
Large platelets
Large platelets 1 1
Smudge
Smudge
cells cells 22 22 11.0 11.0
Results
Results
fromfrom
manual
manual
re-classification
re-classification
The neutrophil
The neutrophil
nucleinuclei
appeared
appeared
mostlymostly
rod-shaped
rod-shaped
or or
bi-lobed,
bi-lobed,
with rod-shaped
with rod-shaped
nucleinuclei
resembling
resembling
peanutspeanuts
or or
eyeglasses,
eyeglasses,
and lobed
and lobed
nucleinuclei
connected
connected
by thinbythreads;
thin threads;
the the
lobes lobes
were mostly
were mostly
roundround
or elliptical;
or elliptical;
the chromatins
the chromatins
were were
dense,dense,
deeplydeeply
stained,
stained,
and aggregated
and aggregated
into small
into blocks
small blocks
or or
rod-like
rod-like
structures;
structures;
hyperlobulated
hyperlobulated
nucleinuclei
were not
wereobserved.
not observed.
CaseCase
analysis
analysis
BasedBased
on theon special
the special
morphology
morphology
of neutrophils,
of neutrophils,
the possibility
the possibility
of hereditary
of hereditary
Pelger-Huët
Pelger-Huët
anomaly
anomaly
was first
wasconsidered
first considered
for thisfor this
patient.
patient.
Thus, clinical
Thus, clinical
consultation
consultation
was made,
was made,
and theandpatient
the patient
was advised
was advised
to undergo
to undergo
a pedigree
a pedigree
analysis
analysis
of immediate
of immediate
family.family.
The patient
The patient
has a son
has aand
sona and
daughter
a daughter
who are
whoboth
are healthy.
both healthy.
CBC samples
CBC samples
were collected
were collected
from the
frompatient's
the patient's
son and
sondaughter
and daughter
the next
theday
nextforday
testing,
for testing,
and theand
results
the results
were normal.
were normal.
The blood
The blood
cell morphology
cell morphology
resultsresults
are shown
are shown
below:below:
White blood
White cells
blood cells Patient's
Patient's
son son
White blood
White cells
blood cells 200 100%
200 100%
Segmented neutrophils
L L Segmented
neutrophils
96 48.0
96 48.0
！ Band
！ neutrophils
37 18.5
Lymphocytes
Lymphocytes 59 29.5
59 29.5
Monocytes
Monocytes 8 4.0
8 4.0
Non-white
Non-white
blood cells
blood cells
48 %
48 %
Giant platelets
Giant platelets 2 2
Large platelets
Large platelets 6 6
PlateletPlatelet
clumpsclumps 1 1
Smudge
Smudge
cells cells 31 15.5
31 15.5
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 40 |
Case Booklet 40
White blood cells Patient's daughter
！ Band neutrophils 72 36.0
Lymphocytes 41 20.5
Monocytes 7 3.5
Metamyelocytes 1 0.5
Myelocytes 1 0.5
Giant platelets 1
Band neutrophils
Large platelets 1
The above results showed that the peripheral blood neutrophil morphologies of the patient's son and daughter were generally
the same as that of the patient, and the neutrophil nuclei were mostly rod-shaped or bi-lobed. The MC-80 microscope was
used to analyze 200 WBCs, and no cells with 3 or more lobes were observed, so the cell morphology was considered to be
congenital Pelger-Huët anomaly.
30 fL
Pelger-Huët anomaly is an autosomal dominant genetic abnormality characterized by reduced lobulation of mature
neutrophils. It is also known as familial neutrophil anomaly or Pelger-Huët neutrophil anomaly.
Morphological features: Reduced lobulation of neutrophils. The nuclei were non-lobulated in an oval shape (e.g.,
kidney-shaped, rod-shaped) or divided into two lobes resembling peanuts, eyeglasses, or dumbbells (similar to panda eyes).
The chromatins were concentrated, deeply stained, and aggregated into small blocks or thread-like structures, forming blank
gaps in between.

16
16
Case
Case
16 16
Green
Green
neutrophilic
neutrophilic
inclusions
inclusions
Clinical
Clinical
information
information
The patient
The patient
was awas
52-year-old
a 52-year-old
female
female
who who
experienced
experienced
pyrexia,
pyrexia,
diarrhea,
diarrhea,
headache,
headache,
fatigue,
fatigue,
and nausea
and nausea
one week
one week
ago. ago.
The highest
The highest
bodybody
temperature
temperature
was 39.5
was °C.
39.5
She
°C.was
Shelater
was admitted
later admitted
to thetointensive
the intensive
care unit
caredue
unitto
due
confusion,
to confusion,
transient
transient
unilateral
unilateral
limb limb
convulsions,
convulsions,
and hematemesis.
and hematemesis.
Subsequently,
Subsequently,
she wasshediagnosed
was diagnosed
with hemophagocytic
with hemophagocytic syndrome
syndrome
secondary
secondary
to severe
to severe
fever fever
with thrombocytopenia
with thrombocytopenia
syndrome
syndrome
virus virus
(SFTSV)
(SFTSV)
infection.
infection.
Peripheral
Peripheral
blood
blood
morphology
morphology
examination
examination
Results
Results
fromfrom
manual
manual
re-classification
re-classification
Neutrophils
Neutrophils
exhibited
exhibited
vacuolar
vacuolar
degeneration
degeneration
and and
demonstrated
demonstrated
bacterial
bacterial
phagocytosis,
phagocytosis,
alongalong
with with
the presence
the presence
of blue-green
of blue-green
roundround
inclusions
inclusions
in both
in both
neutrophils
neutrophils
and eosinophils.
and eosinophils.
Case
Case
analysis
analysis
After After
the discovery
the discovery
of blue-green
of blue-green
inclusions,
inclusions,
high-sensitivity
high-sensitivity
cardiaccardiac
troponin
troponin
I (hs-cTnI),
I (hs-cTnI),
alanine
alanine
aminotransferase,
aminotransferase,
WBCs,WBCs,
and and
otherother
test indicators
test indicators
continued
continued
to increase
to increase
or remained
or remained
at highat levels,
high levels,
and the
andNRBC
the NRBC
percentage
percentage
was aswas
high
as as
high
20%.
as Six
20%.days
Six days
later, the
later,myocardial
the myocardial
and pancreatic
and pancreatic
damagedamage
caused
caused
by thebyinflammatory
the inflammatory
cytokine
cytokine
stormstorm
did not
didshow
not show
significant
significant
improvement,
improvement,and the
andpatient
the patient
eventually
eventually
died. died.
Blue-green
Blue-green
inclusions
inclusions
are bright
are bright
greengreen
inclusions
inclusions
that appear
that appear
in theincytoplasm
the cytoplasm
of neutrophils
of neutrophils
or monocytes,
or monocytes,
and areandusually
are usually
associated
associated
with acute
with acute
liver failure,
liver failure,
lacticlactic
acidosis,
acidosis,
and other
and other
diseases.
diseases.
Their Their
appearance
appearance
indicates
indicates
that the
thatpatient
the patient
is in critical
is in critical
conditions,
conditions,
whichwhich
can alert
can clinicians
alert clinicians
to closely
to closely
monitormonitor
the patient's
the patient's
emergency
emergency
situation,
situation,
actively
actively
treat the
treatunderlying
the underlying
disease,
disease,
protect
protect
the liver,
the and
liver,promptly
and promptly
correctcorrect
lacticlactic
acidosis.
acidosis.
This may
This change
may change
the patient's
the patient's
outcome.
outcome.
HemaCase—Clinical
HemaCase—Clinical
Case Booklet | 42 |
Case Booklet 42
Long-standing Problems Associated With PLT Aggregation
In vitro platelet aggregation is commonly caused by EDTA-dependent pseudo thrombocytopenia (EDTA-PTCP) in clinical practice.
It has been reported that the incidence of EDTA-PTCP is 0.07% ~ 0.20%, while the incidence among platelet donors is 0.2% and
that among hospitalized patients is 0.1% ~ 2.0%[1]
Challenges for Clinical Departments in Handling Samples With Low PLT Counts
Complex low PLT count screening Complicated time-consuming microscopic Repeated blood collections
may lead to false low count reports examinations add to the workload trigger patient complaints
Clinical Disputes Uncontrolled TAT Unsatisfactory Patient Experience
Difficulties Encountered by Traditional Instruments in Handling EDTA-PTCP Samples
The instrument The procedure is Deviations in False reports Patients under

only provides complex and the sample processing may cause intensive care may
alerts but cannot timing of its require additional misdiagnosis develop iatrogenic
perform completion blood collections anemia[2]
de-aggregation beyond control.
Address PLT Aggregation-related Challenges Easily With PLT De-aggregation

Technology

New Technology for Interference Elimination
Mindray is committed to solving the genuine concerns of customers and pursuing excellence. The groundbreaking PLT
de-aggregation technology consolidates 6 years of collaboration with reputable institutions and guidance from experts,
successfully addressing the PLT aggregation-related challenges in clinical laboratory settings.
an t nt rte
x
a t to te tan ge vo SS FL
he pria re ons g ea d
r e o
P pr ra t a t u c ts -ag n r pee PM
le De atio h-s R
ap pe in a re Plate reg Hig 14
00
tem inta ratu The platelets pass
Ma pe through the detection
tem
area one by one to
Optimal temperature Specially developed Vortex mixing and enable precise detection
for de-aggregation, de-aggregation reagent high-speed of aggregated platelets
regardless of regional formulation promotes separation uniformly

temperature variations repulsion among platelets disperse platelets. FS
Constant De-aggregation Dispersion Testing
temperature
Process Comparison: De-aggregation Process is 4+ times More Efficient Than

Traditional Process Note: The testing time is estimated from the daily work of grade A tertiary hospitals
(including a waiting time of 57 mins)
Traditional 2 mins 5 mins 5 mins 5 mins 20 mins 10 mins 5 mins 5 mins
Process Blood collection Testing Check Optical re-testing Prepare smears, Using a different Re-testing Re-check
perform microscopic anticoagulant Additional
examination blood collections
2 mins 5 mins 1 mins 5 mins
De-aggregation
Blood collection Testing Automated optical re-testing Validation
Process
(including a waiting time of 13 mins)
De-aggregation Technology Effectively Addresses Spurious Low PLT Count

Due to EDTA-PTCP
Assessment of test results of EDTA-PTCP cases
600
500 Sodium citrate,PLT-O

400
PLT count
Sodium citrate,PLT-I
300
EDTA,PLT-O
200
EDTA,PLT-I
100
0
Note: The assessment report
Case1 Case2 Case3 Case4 Case5 Case6 Case7 Case8 Case9 Case10 Case11 Case12 Case13 Case14 Case15 is provided by a third party.
Advanced Hematology Analyzer & De-aggregation Technology

The instrument and technology not only can handle the samples affected by EDTA-PTCP, but also automates the entire
de-aggregation process without the need for manual intervention. This uniformly controls the TAT and enhances operational
efficiency and convenience in laboratories.

References:
1、Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and
acute leukemia[J]. Blood,2016,127(20):2391-2405.
2、中国抗癌协会血液肿瘤专业委员会 , 中国医师协会肿瘤医师分会 , 中国医疗保健国际交流促进会肿瘤内科分会 . 套细胞淋巴瘤诊

断与治疗中国指南（2022 年版）[J]. 中华血液学杂志 ,2022,43(7):529-536.
3、中国抗癌协会血液肿瘤专业委员会 , 中华医学会血液学分会 , 中国慢性淋巴细胞白血病工作组 . 中国慢性淋巴细胞白血病 / 小淋

巴细胞淋巴瘤的诊断与治疗指南（2022 年版）[J]. 中华血液学杂志 ,2022,43(5):353-358.
4、卢兴国，叶向军，徐根波 . 骨髓细胞与组织病理诊断学 [M]. 北京 : 人民卫生出版社，2020
5、高海燕，刘亚波，吕成芳，陈雪艳 . 血液病临床检验诊断 [M]. 北京：中国医药科技出版社，2021.3
6、Döhner H, Wei A H, Appelbaum F R, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international
expert panel on behalf of the ELN[J]. Blood, 2022,140(12):1345-1377.
7、Claire Bories, Thomas Boyer, t(6;9)(p23;q34.1) acute myeloid leukaemia with cuplike blasts.[J] .Br J Haematol, 2018 Jul; 182(1): 9.
8、郝冀洪 , 朱芸 , 李顺义 , 宋文杰 . 血小板减少、粒细胞包涵体、巨大血小板 . 中华检验医学杂志 ,2008,31:589-591.
9、Samir S Shah, Rupali S Parikh, et al. Familial Pelger-Huet Anomaly[J]. Indian J Hematol Blood Transfus. 2016;32:347-350.
10、中华医学会检验医学分会血液学与体液学学组 . 血细胞分析报告规范化指南 . 中华检验医学杂志 ,2020,6(43):619-627.
11、Palmer L, Briggs C, McFadden S, et al. ICSH recommendations for the standardization of nomenclature and grading of peripheral
blood cell morphological features. Int J Lab Hematol.2015;37:287-303.
12、Mauro Buttarello, Giacomo Mezzapelle, et al. Reticulated platelets and immature platelet fraction: clinical applications and method
limitations[J]. International Journal of Laboratory Hematology. 2020 Aug;42,4:363-370.
13、Khodaiji, S. Newer CBC Parameters of Clinical Significance[J]. Hematopathology, Springer, 2019,3-25.
14、Wei Jiang, Ming Huang, Jiao-Hua Chen, et al. A case of neutrophil blue-green inclusions in severe fever with thrombocytopenia
syndrome virus infection[J]. Int J Lab Hematol.2023;1-4.

Follow Mindray on Social Media
@MindrayMedical
www.mindray.com
P/N:ENG-HemaCases-Clinical Case Booklet Volume 1-210285X48P-20230605
This product leaflet and its contents are for internal communication only. The details of the product
can be found in the actual product and related materials. No unit or individual may copy, quote,
distribute or reproduce without our permission.
©2023 Shenzhen Mindray Bio-Medical Electronics Co.,Ltd. All rights reserved.

Hemacases Vol 1

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Hemacases Vol 1

Transféré par

Droits d'auteur :

Formats disponibles

HemaCase

Clinical Case Booklet

03 | HemaCase—Clinical Case Booklet

Neu Neutrophil Eos# Eosinophil count RET% Reticulocyte percentage

Neu% Neutrophil percentage Bas Basophil IRF Immature reticulocyte fraction

Lym Lymphocyte Bas# Basophil count PLT Platelet

Mon# Monocyte count MCV Mean corpuscular volume

Mon% Monocyte percentage NRBC Nucleated RBCs

Scattergrams of 5-part differential hematology analyzer

1 Abnormal lymphocytes 5 Neutrophils and basophils

WNB Scattergram RET Scattergram

1 Nucleated RBCs 1 Mature red blood cells

HemaCase—Clinical Case Booklet | 04

Item Parameter Result

CBC results on Jun. 1

Neu% & R L 26.2 -9.40 35.6 28.2 %

P-LCR R 44.8 -2.00 46.8 61.3 %

07 | HemaCase—Clinical Case Booklet

! Blasts ! Blasts 112 112

Peripheral blood morphology results on Aug. 24

White blood cells

! Blasts 215 66.2

Non-white blood cells 92 %

Smudge cells 79 24.3

09 | HemaCase—Clinical Case Booklet

CBC results on Nov. 1

11 | HemaCase—Clinical Case Booklet

Color Color Degree Degree % %

TT TT 18.6 18.6 11.0-17.8

CBC results on Nov. 5

Parameter Alarm Result Unit

13 | HemaCase—Clinical Case Booklet

Parameter Alarm Result Unit

RBC L 2.70 10^12/L

15 | HemaCase—Clinical Case Booklet

Results from manual re-classification

Bone marrow cytology examination

HemaCase—Clinical Case Booklet | 16

Parameter Alarm Result Unit

Decreased trilineage, severe anemia, increased Bas%.

17 | HemaCase—Clinical Case Booklet

Gene Gene DEK-CANDEK-CAN

Item Parameter Result Item Paramet Result

19 | HemaCase—Clinical Case Booklet

Color Color Degree Degree % %

Shape Shape Degree Degree % %

TBIL TBIL 45.5μmol/L

21 | HemaCase—Clinical Case Booklet

WBCs were generally normal; macrocytic anemia; extremely low PLT.

Parameter 1-31 2-1 2-2 2-4 3-1

23 | HemaCase—Clinical Case Booklet

Neu# Neu# & R& R 5.05 5.05 10^9/L 10^9/L

Lym# Lym# R R 2.35 2.35 10^9/L 10^9/L

Mon# Mon# R R 5.62 5.62 10^9/L 10^9/L

Eos# Eos# R LR 0.01

Bas# Bas# R R 0.01 0.01 10^9/L 10^9/L

IMG# IMG# R R 1.20 1.20 10^9/L 10^9/L

Lym% Lym% R LR 18.0

Mon% Mon% R HR 43.1

Eos% Eos% R LR 0.1L 0.1 % % DIFFDIFF WNBWNB

IMG% IMG% R R 9.2 9.2 % % FL FL FS FS

RBC RBC L 2.63

HGB HGB L 75L 75 g/L g/L