Blood Res 2020; 55(1):
Published online March 31, 2020
https://doi.org/10.5045/br.2020.55.1.62
© The Korean Society of Hematology
Correspondence to : Bohyun Kim
Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
E-mail: bhkim@schmc.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
It is well known that
A 68-year-old woman was admitted with increased hemoglobin (Hb) and leukocyte count. Complete blood count (CBC) at admission showed the following: white blood cells, 17.06×109/L; Hb, 17.3 g/dL; and platelets, 245×109/L. Peripheral blood smear demonstrated leukoerythroblastosis with the presence of few tear drop cells. Differential counts of leukocytes were as follows: myelocytes 1%, metamyelocytes 1%, neutrophil 84%, lymphocytes 9%, monocytes 4%, eosinophil 1%, and rare nucleated red blood cells. Her serum lactate dehydrogenase level was elevated (313 IU/L, reference range, 0–250 IU/L) while her serum erythropoietin level was decreased (3.06 mIU/L, reference range, 3.7–37.5 mIU/L). An abdominopelvic computed tomography showed splenomegaly. We could not acquire sufficient information from the bone marrow aspirate, because it was diluted. However, bone marrow biopsy revealed hypercellularity and a slightly increased number of megakaryocytes (3.4/high power field) with dense clustering and certain degree of atypia (Fig. 1). Diffuse myelofibrosis, with bone marrow fibrosis (MF) grade 2, was detected (Fig. 1). Reverse-transcriptase PCR (RT-PCR) assay for the
Detecting
The coexistence of these abnormalities may affect laboratory findings and patient diagnosis. Park et al. [3] reported two cases of MPN, with a relative
The molecular abnormality profile can influence the choice of treatment modalities. Cases reported by Park et al. [3] and our patient showed acceptable responses to hydroxyurea. However, the case reported by Yi and Kim [4] showed treatment responses to dasatinib (a tyrosine kinase inhibitor), hydroxyurea, and ruxolitinib (a JAK1/2 tyrosine kinase inhibitor) (Table 1). Other studies [6, 9] have reported successful responses to the simultaneous use of tyrosine kinase inhibitors and hydroxyurea or ruxolitinib in patients with concomitant
Another issue is the impact of molecular abnormalities on patient outcomes. Soderquist et al. [8] have reported that seven of 11 MPN patients with concurrent
In summary, it is important to recognize the possibility of the coexistence of a
No potential conflicts of interest relevant to this article were reported.
Abbreviations: CML, chronic myeloid leukemia; ET, essential thrombocythemia; FISH, fluorescence
Blood Res 2020; 55(1): 62-65
Published online March 31, 2020 https://doi.org/10.5045/br.2020.55.1.62
Copyright © The Korean Society of Hematology.
Bohyun Kim1, Kyu Taek Lee2, Young Ahn Yoon1, Young-Jin Choi1
1Department of Laboratory Medicine, 2Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
Correspondence to:Bohyun Kim
Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
E-mail: bhkim@schmc.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
It is well known that
A 68-year-old woman was admitted with increased hemoglobin (Hb) and leukocyte count. Complete blood count (CBC) at admission showed the following: white blood cells, 17.06×109/L; Hb, 17.3 g/dL; and platelets, 245×109/L. Peripheral blood smear demonstrated leukoerythroblastosis with the presence of few tear drop cells. Differential counts of leukocytes were as follows: myelocytes 1%, metamyelocytes 1%, neutrophil 84%, lymphocytes 9%, monocytes 4%, eosinophil 1%, and rare nucleated red blood cells. Her serum lactate dehydrogenase level was elevated (313 IU/L, reference range, 0–250 IU/L) while her serum erythropoietin level was decreased (3.06 mIU/L, reference range, 3.7–37.5 mIU/L). An abdominopelvic computed tomography showed splenomegaly. We could not acquire sufficient information from the bone marrow aspirate, because it was diluted. However, bone marrow biopsy revealed hypercellularity and a slightly increased number of megakaryocytes (3.4/high power field) with dense clustering and certain degree of atypia (Fig. 1). Diffuse myelofibrosis, with bone marrow fibrosis (MF) grade 2, was detected (Fig. 1). Reverse-transcriptase PCR (RT-PCR) assay for the
Detecting
The coexistence of these abnormalities may affect laboratory findings and patient diagnosis. Park et al. [3] reported two cases of MPN, with a relative
The molecular abnormality profile can influence the choice of treatment modalities. Cases reported by Park et al. [3] and our patient showed acceptable responses to hydroxyurea. However, the case reported by Yi and Kim [4] showed treatment responses to dasatinib (a tyrosine kinase inhibitor), hydroxyurea, and ruxolitinib (a JAK1/2 tyrosine kinase inhibitor) (Table 1). Other studies [6, 9] have reported successful responses to the simultaneous use of tyrosine kinase inhibitors and hydroxyurea or ruxolitinib in patients with concomitant
Another issue is the impact of molecular abnormalities on patient outcomes. Soderquist et al. [8] have reported that seven of 11 MPN patients with concurrent
In summary, it is important to recognize the possibility of the coexistence of a
No potential conflicts of interest relevant to this article were reported.
Abbreviations: CML, chronic myeloid leukemia; ET, essential thrombocythemia; FISH, fluorescence