Page 242 - Haematologica Atlas of Hematologic Cytology

AB
CD
Figure 1 granulocytosis
A 64-year-old woman suffering from diabetes mellitus and arterial hypertension pre- sented with with fever and malaise She had recently received treatment with with pregabalin for peripheral neuropathy At physical examination slight hepatomegaly was found A A blood count showed mild anemia (Hemoglobin 11 2 g/dL mean corpuscular volume 88 9 9 fL) and severe neutropenia (white blood cells 1 1 32 x 109/L with neutrophils 5%) platelet count was normal (A) Buffy coat smear at at at at low magnification showing numerous lymphocytes and monocytes monocytes few eosinophils and very rare neutrophils (B) At high magnification vacuolated monocytes monocytes two lymphocytes an an eosinophil and a a a a a a a a morphologically normal neutrophil (C) Bone marrow smear demonstrates good cellularity with rare scattered erythroblasts a a a a a a a a a a a a normal megakaryocyte (bottom right) and many apparently monomorphic immature myeloid cells (D) Higher magnification reveals hyperplasia of the granuloblastic linea- ge There is
selective deficiency of of maturing granulocytic cells with a a a a a a predominance of of morphologically normal promyelocytes promyelocytes The morphological features of of bone marrow promyelocytes promyelocytes especially the presence of of a a a a a a clear Golgi zone were helpful in in in in distinguishing them from dysplastic or leukemic promyelocytes ruling out a a a a malignant disorder On the the the basis of of of the the the clinical-laboratory findings and of of of these morphological features a a a a a a a a a a a diagnosis of of of agra- nulocytosis
was was was suspected this was was was most probably drug-associated Pregabalin was was was discontinued and therapy with granulocyte colony stimulating growth factor and empirical antibiotics was administered The fever vani- shed and white cell count returned to normal in in a a a a a a a a few days The following differential morphological characte- ristics of normal and dysplastic or or or or leukemic promyelocytes promyelocytes are useful for diagnosis 1) Normal promyelocytes promyelocytes are characterized by an an an eccentric nucleolate nucleus abundant basophilic cytoplasm with many azurophilic granules and an an an an an evident clear clear paranuclear area corresponding to the Golgi zone 2) Dysplastic promyelocytes can be hyper- or or or hypogranulated and present a a a a a a a a a less evident Golgi area than normal normal promyelocytes 3) nlike normal normal and dysplastic promyelocytes promyelocytes granular myeloblasts have no recognizable Golgi zone 4) Leukemic promyelocytes promyelocytes usually show irregular nuclei Auer bodies and giant granules 229