Rapid 2

A 30 year old man presents with dull pain in his right hip, which started 4 months ago, and has gradually increased in severity. He also experienced an intermittent, low grade fever during this time.

His medical and surgical histories are unremarkable. He does not smoke or consume alcohol, and denies drug abuse.

A complete blood count reveals a total leukocyte count of 15,000/mm3, a neutrophil count of 1,510/mm3, a Hb level of 9.1 g/dL and a platelet count of 118,000/mm3. A followup peripheral blood smear demonstrates 15% blast cells.

Select Relevant Investigations
X-ray Hip Joints & Pelvis

Performed

The x-ray reveals ill defined areas of radiolucency in the right iliac bone, right acetabular bone and marrow spaces.
Bone marrow aspiration and biopsy

Performed

The bone marrow contains 36% blasts.
Blasts were negative for peroxidase (POX) and naphthol AS-D chloroacetate esterase (CE) indicating a myeloid lineage.
The biopsy demonstrates a fibrotic marrow with areas of hyperplasia.
Immunophenotyping

Performed

A flow cytometric analysis (FCM) demonstrates positive HLA DR+, CD117+, CD34+, CD33+, CD38+, cMPO+ in abnormal cells, confirming myeloid phenotype.
Cytogenetics

Performed

Result will be available in 1 week

Select Relevant Management
Blood Transfusion
Radiotherapy
Chemotherapy
Stem cell transplantation