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WBC: 29.6; HGB: 4.7; HCT: 13.4%; MCV: 85.9 fL; PLT: 900 (Diff: 36% polys; 30% lymphs; 12% monos; 6% eos; 2% basos; 1% myelocytes; 13% blasts; 12 nRBCs/100WBC). Peripheral blood smear. What is your differential diagnosis?
Two days later, after RBCs and fluids: WBC: 8.1; HGB: 9.2; HCT: 25.2; MCV: 85 fL; PLT: 250 (Diff: 47% polys; 29% lymphs; 7% monos; 8% blasts; 7% eos; 2% basos; 2% metas Bone marrow biopsy (HE, reticulin stain) and touch prep (clot). What is your differential diagnosis?
Annotations and notes
Clinical history
20-month old boy with splenomegaly, thrombocytosis, severe anemia and peripheral blasts WBC: 29.6; HGB: 4.7; HCT: 13.4%; MCV: 85.9 fL; PLT: 900 (Diff: 36% polys; 30% lymphs; 12% monos; 6% eos; 2% basos; 1% myelocytes; 13% blasts; 12 nRBCs/100WBC). Peripheral blood smear. What is your differential diagnosis? Two days later, after RBCs and fluids: WBC: 8.1; HGB: 9.2; HCT: 25.2; MCV: 85 fL; PLT: 250 (Diff: 47% polys; 29% lymphs; 7% monos; 8% blasts; 7% eos; 2% basos; 2% metas Bone marrow biopsy (HE, reticulin stain) and touch prep (clot). What is your differential diagnosis?
Diagnosis
Juvenile chronic myelomonocytic leukemia (JMML), with some atypical features in the setting of neurofibromatosis type I
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