keepgoing
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A 10-year-old girl is brought to the doctor with malaise, pallor, low-grade fever, and weight loss. She says that she has had several nose bleeds recently. Her complete blood count shows a markedly elevated white blood cell count. Bone marrow aspirate shows 35% myeloblasts and 55%
erythroblasts. According to the FAB classification, which acute myelogenous leukemia does this
patient have?
A. M2
B. M3
C. M4
D. M5
E. M6
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| jean robert
Forum Guru
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Maybe E????
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| new_n_lost
Politically InCorrect
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E Acute erythroleukemia
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| lq2006
Forum Elite
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E
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| keepgoing
Forum Guru
Topics: 62
Posts: 1,673
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The correct answer is E. The FAB classification (French American British) sorts AML into seven
categories (M1-M7). If the marrow has greater than 30% blasts, of which more than 50% are
erythroblasts, then the diagnosis is M6. The symptoms described are the typical presenting
features of AML. Only half of AML patients actually present with elevated WBCs.
M2 (choice A), or myeloblastic leukemia with maturation, is characterized by greater than 30%
blasts, with more than 50% of the blasts being myeloblasts and promyelocytes. Mature forms are
seen as well. Eosinophils may be heavy in some cases.
M3 (choice B), or hypergranular promyelocytic leukemia, is characterized by greater than 30%
blasts. The majority of cells have a promyelocytic appearance with kidney-shaped nuclei. Auer
rods are usually seen in the cytoplasm.
M4 (choice C), or myelomonocytic leukemia, is characterized by greater than 30% blasts, with
promonocytes and monocytes accounting for more than 20% of the bone marrow aspirate.
M5 (choice D), or monocytic leukemia, is divided into differentiated and poorly differentiated.
There are more than 30% blasts; the granulocyte component is less than 10% of marrow cells. The
monocytes can be detected cytochemically with the fluoride-sensitive esterase reaction.
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