MM250721: Acute lymphoblastic leukaemia (ALL)

This week’s case featured a 14-year-old male who presented with symptoms prompting a full blood count and peripheral blood film examination.

Key FBC results:

• WBC: Elevated at 37.83 ×10⁹/L

• Hb: Reduced at 87 g/L

• PLT: Markedly decreased at 19 ×10⁹/L

• RBC: 2.93 ×10¹²/L

• MCV: Normocytic at 87.4 fL

• RDW: 16.4%

Blood film features:

• Approximately 78% blast cells seen.

• Blasts were predominantly lymphoid in appearance, with high N:C ratios, delicate chromatin, and occasional nucleoli.

• Neutrophils and monocytes were rare.

• Marked thrombocytopaenia was confirmed visually, aligning with the automated count.

Interpretation:

The findings are highly suggestive of an acute leukaemia, and given the age of the patient it raises a strong suspicion for acute lymphoblastic leukaemia (ALL), which is the most common type of acute leukaemia in children and adolescents.

Although morphology provides a critical initial clue, immunophenotyping by flow cytometry is essential to confirm the lineage (B- or T-cell) and subtype the leukaemia. Cytogenetic and molecular studies will guide prognosis and therapy.