Monthly Cell Challenge #4 / 2025

 

2-year-old with large blast-like cells 

A 2-year-old girl went to a pediatrician with her parents because of unexplained fever, fatigue, weakness, weight loss and shortness of breath. They also noticed small red spots on the skin and easy bruising. The pediatrician ordered a CBC and differential.  

CBC results: 

Test	Result	Units
WBC	94,5	x109/L
HGB	66	g/L
MCV	77	fL
PLT	11	x109/L

Smear analysis on CellaVision® DM-9600:

WBC Differential	%	x109/L
Band neutrophils	2,9	2,7
Neutrophils	16,3	15,4
Basophils	1,9	1,8
Lymphocytes	10,6	10,0
Monocytes	15,4	14,6
Blasts	52,9	50
NRBC	24/100 WBC

In the CellaVision® Remote Review Software, the on-call hematopathologist could see that there was neutropenia with toxic granulation, some large granular lymphocytes (LGLs), monocytes with immature appearance, and a high number of nucleated red blood cells (NRBC) in varying maturation stages and dysplastic features.    

She could also see a high number of large immature cells with blast like nuclei, and with one or more nucleoli, abundant basophilic cytoplasm with fine scattered azurophilic granules and vacuolization.

Some of these immature cells showed folded and convoluted nuclei, with fine lace-like chromatin structure and a grey blue cytoplasm with azurophilic granules and vacuoles.   

Flow cytometry: CD2-, CD4+, CD10-, CD11b+, CD14+, CD19-, CD22-, CD34+, CD64+, HLA-DR+.