With high degree of clinical suspicion, especially in childhood population, even the presence of granules in lymphoblast like cells with absence of Auer rods
should prompt evaluation by cytochemistry.
Bone marrow biopsy and aspiration revealed that 65% of the bone marrow cells were monoblasts with fine chromatin, granular cytoplasm, and no Auer rods
Review of peripheral blood smear (Figure 1) demonstrated many primitive cells with round and lobated nuclei, numerous cytoplasmic granules with Auer rods
readily identified, and some cells with multiple Auer rods
Morphology showed normochromic, anisocytosis, Rouleaux formation, circulating blast cells with Auer rods
, bicytopenia with leukocytosis, neutrophils: 0.7%, lymphocytes: 23%, monocytes: 03%, Blasts: 67%.
Her peripheral blood smear and bone marrow biopsy demonstrated blasts containing Auer rods
, diagnostic of AML (figure 1).
The bundles of Auer rods
are recognized easily with the latter stains but not the former.
Most cases have identifiable faggot/matchstick cells with numerous Auer rods
. (10,12) On the other hand, hypogranular APL presents with leukocytosis, and numerous abnormal promyelocytes are readily identified on a peripheral blood smear.
A cytochemical and ultrastructural study of acute myelomonocytic leukemia exhibiting the pseudo-Chediak-Higashi anomaly of leukemia and "splinter-type" Auer rods
. Am J Clin Pathol 1983;80:216-223.
TEST RESULTS REFERENCE RANGE Complete Blood Count WBC 16.3 K/[mu]L 4.0-10.5 K/[mu]L RBC 2.60 M/[mu]L 4.2-5.6 M/[mu]L HgB 7.1 g/dL 12.5-16.1g/dL HCT 21.0% 36.0-47.0% Platelets 30 K/[mu]L 150-450 K/[mu]L Differential Neutrophils 3% 33-61% Lymphocytes 10% 25-45% Blasts 87% 0% Nucleated RBC's 2 RBC Morphology Polychromasia WBC Morphology Auer rods
present D-Dimer 18.8[micro]g/mL <0.5 Fibrinogen 155mg/dL 200-500 mg/dL PTINR 16.4 sec 12.8-14.4 sec INR 1.3 (calculated) PTT 31.1 sec 23.9-36.6 sec ALT 12U/L 21-72 U/L Uric Acid 3.0 mg/dL 4.0-8.6 mg/dL Table 1.
Hypergranular acute promyelocytic leukemia (APL): The most common morphologic variant of APL, representing approximately 75% of cases, is characterized by bone marrow containing large, abnormal promyelocytes with pleomorphic nucleoi and cytoplasm containing coarse, large granules with abundant Auer rods
, often in bundles.
In the typical case of APL, diagnosis is not difficult, as the neoplastic population consists of numerous cytologically atypical cells that resemble promyelocytes, frequently containing single or multiple Auer rods
(Figure 1, A).
Some of these cells showed Auer rods
. Normal haematopoiesis was suppressed although all three cell lines were seen.