Peripheral smear with increased neutrophils, basophils, eosinophils, and platelets is highly suggestive of-
Correct Answer: Chronic myelogenous leukemia
Description: Answer is C (Chronic myelogenous leukemia): Peripheral blood picture with excessive number of granulocytes, basophills and eosinophils is characteristic of chronic myeloid leukemia (CML). CML is also often associated with an elevated Platelet count (thrombocytosis) sometimes to strikingly very high levels. Chronic myelocytic leukemia is the single hest answer of choice. CML Chronic myeloproliferative disorder from neoplastic transformation of a bone marrow stem cell that still retains capacity to differentiate along erythrocytic, megakaryocytic and granulocytic or monocytic lines. Pripheral blood picture Striking Leucocytosis (Elevated WBC count) Both immature and mature farms in different Stages of maturation may be seen But Blood picture is dominated hp Mature forms and precursor in the intermediate staj'es of differentiation (Neutrophils, Metamyelocytes and Myelocytes) Immature forms are less numerous Blasts <5% Promyelocytes <10% (Cells are usually present in direct degree to the stage of maturation) Basophills Eosinophils may be increased - Elevated Basophils (often present) - Elevated Eosinophils (less common) Thrombocytosis Elevated platelet count if often present. Platelet count may be normal or sometimes elevated to strikingly high levels Erythrocytes Red blood cell morphology is normal. Patient is usually not anemic or only mildly anemic Bone marrow Bone marrow is hypercellular with left shifted myelopoesis Myeloid: Erythroid ratio is increased Myeloblasts comprises less than 5% of marrow cells Special Tests Cytogenetic Analysis for Philadelphia Chromosome - A small chromosome 22 caused by t (9; 22) translocation that results in bcr/abl fusion gene Reduced Leukocyte alkaline phosphatase levels (.SLAP) - This indicates that although the total number of granulocytes is increased they are functionally impaired Serum levels of vitamin Bp_proteins is "red binding.
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