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Case study (21)- Acute myelomonocytic leukemia (AMML)

Case study (21)- Acute myelomonocytic leukemia (AMML) 

History and clinical signs and symptoms 

A 65-year-old woman was diagnosed with acute myelomonocytic leukemia (AMML) 3 months before. 

According to leukocytosis, the highly prevalent atypical bone marrow cells in peripheral blood are suspected to be AMML. 

The use of appropriate flow cytometry and cytogenetics methods established an accurate diagnosis. 

The patient returned to the next course of chemotherapy. 

There was a marked susceptibility for bruising. Physical signs and symptoms were not specific. 

Laboratory Investigations 

1. Hematologic findings 

RBC:3.51 X 106/μL (4-5.5 X 106/μL) 
HGB: 97 g/dL (120-174 g/dL) 
HCT: 31.7 % (36-52%)
MCV: 90.4 fL (76–96 fL)
MCH: 27.6 pg (27-32 pg)
MCHC: 305 g/L (300-350 g/L) 
RDWsd:39.9 fL (20-42 fL) 
RDWcv: 13.7 % (0-16 %) 
WBC: 8.45 X103/ μL (5–10 X 103/ μL) 
Neutrophils: --- X 103/μL (2-7.5 X 103/μL) 
Lymphocytes: --- X 103/μL (1.08–3.17 X 103/μL) 
Monocytes: --- X 103/μL (0.15-0.7 X 103/μL) 
Eosinophils: --- X 103/μL (0-0.5 X 103/μL) 
Basophils: 0.04 X 103/μL (0-0.15 X 103/μL) 
Neutrophils %: --- % (40-75 %) 
Lymphocytes %: --- % (14.76-45.4 %)
Monocytes %: --- % (3-7 %)
Eosinophils %: --- % (0-5 %) 
Basophils %: 0.5 % (0-1.5 %) 
PLT: 89 X 103/μL (150-400 X 103/μL) 

Warning Flags AD, Morphological Flags G, Interpretive Flags Anemia? 


The instrument presented the normal WBC count without any differential counts. The WBC differential scattergram is abnormal, indicating that the population has merged; the peripheral blood smear should be analyzed 

According to the WBC scattergram, the instrument cannot able to identify a large number of (possibly abnormal morphological) cells (please refer to the warning signs "A" and "D") 

Morphological flag ‘G’ indicates immature granulocytes. 

Blasts, immature and abnormal cells cannot be determined reliably with the HumaCount 5L system. 

The RBC and PLT histograms are of normal shape and well separated. 

The RBC count, HGB, and HCT levels are 

reduced pointed to anemia (see flag). The red blood cell (RBC) population is homogeneous; the cell size and hemoglobin content are within the normal range. 

Because of the presence of the warning flags AD and the absence of WBC differential counts, it is important to evaluate peripheral blood smears.

Peripheral blood smear 


The peripheral blood smear is characterized by the highly abundant mononuclear cells; these similar to the immature form of monocytes (i.e. pro-monocytes). The peripheral blood smear corresponds to the clinical diagnosis’. 

2. Other laboratory findings 

- Other laboratory findings are not remarkable. 


Acute myelomonocytic leukemia

Disease course 

- The chemotherapeutic cycles were continued.