APHCON Abstracts from the 4th International Hematologic Malignancies Conference: Bridging the Gap 2013 (BTG2013) Hong Kong, 22–23 February 2013

No. 1; Abstract Category: Leukemia Abstract Title: Erythroleukemia with hemophagocytosis Full Name: Tummidi Santosh E-mail: born_vss@yahoo.co.in Institution/Company: MKCG Medical College, India Other Authors: Manoj Kumar Patro, Jayanti Naik, Bodhisatwa Behera, Atanu Kumar Bal, Anita Choudhary, Swayamprabha Paradhan, Debi Prasad Mishra Abstract Details: Background: Acute myeloid leukemia (AML) M6 is uncommon, accounting for  1% of all acute leukemic cases and 3 – 4% of AML. Di Gulielmo first reported the original case of acute erythroid leukemia in 1917. The following are definitions according to the World Health Organization (WHO) 2008 classification: pure erythroid leukemia (French – American – British [FAB] subtype b): erythroblasts  80% of bone marrow nucleated cells with no evidence of a significant myeloblastic component; erythroid leukemia (erythroid/myeloid FAB subtype a):  50% erythroid precursors in bone marrow (BM) nucleated cells, 20% myeloblasts in non-erythroid cells. Hemophagocytosis has no known association with AML. The rarity of association of hemophagocytosis with erythroleukemia has prompted us to report this case. Case report: A 36-year-old Hindu female presented with fatigue, generalized body aches and pain for the last 6 weeks. The patient ’ s peripheral blood showed a leukoerythroblastic blood picture with hemoglobin (Hb) of 3.4 g/dL, total leukocyte count (TLC) 6400/mm 3 and platelet count of 89 000/ mm 3 . Bone marrow aspirate and biopsy revealed a markedly hypercellular bone marrow replaced by erythroid precursors, representing approximately 53% of the marrow cells and myeloblasts representing 49% of non-erythroid cells. The erythroid precursors displayed dysplastic morphology, including megaloblastic features, multinucleation, nuclear lobation and budding, and they were periodic acid – Schiff (PAS)-positive. The presence of hemophagocytosis was noted. Immunohistochemistry (IHC) showed positivity for GLY-A and CMPO, so a diagnosis of acute erythroid leukemia (erythroid/ myeloid) with hemophagocytosis was made.Details: Background: Acute myeloid leukemia (AML) M6 is uncommon, accounting for  1% of all acute leukemic cases and 3 – 4% of AML. Di Gulielmo first reported the original case of acute erythroid leukemia in 1917. The following are definitions according to the World Health Organization (WHO) 2008 classification: pure erythroid leukemia (French – American – British [FAB] subtype b): erythroblasts  80% of bone marrow nucleated cells with no evidence of a significant myeloblastic component; erythroid leukemia (erythroid/myeloid FAB subtype a):  50% erythroid precursors in bone marrow (BM) nucleated cells, 20% myeloblasts in non-erythroid cells. Hemophagocytosis has no known association with AML. The rarity of association of hemophagocytosis with erythroleukemia has prompted us to report this case. Case report: A 36-year-old Hindu female presented with fatigue, generalized body aches and pain for the last 6 weeks. The patient ’ s peripheral blood showed a leukoerythroblastic blood picture with hemoglobin (Hb) of 3.4 g/dL, total leukocyte count (TLC) 6400/mm 3 and platelet count of 89 000/ mm 3 . Bone marrow aspirate and biopsy revealed a markedly hypercellular bone marrow replaced by erythroid precursors, representing approximately 53% of the marrow cells and myeloblasts representing 49% of non-erythroid cells. The erythroid precursors displayed dysplastic morphology, including megaloblastic features, multinucleation, nuclear lobation and budding, and they were periodic acid – Schiff (PAS)-positive. The presence of hemophagocytosis was noted. Immunohistochemistry (IHC) showed positivity for GLY-A and CMPO, so a diagnosis of acute erythroid leukemia (erythroid/ myeloid) with hemophagocytosis was made.