case_images: PMC5667532_01
case_images: Morphological and immunophenotypic characteristics of i(17q).. a) May-Grunwald-Giemsa stained peripheral blood smear at diagnosis revealed a hyposegmented neutrophils with ringed nuclei (x100).. b) Representative flow cytometry plots showing blast positivity (black color) for CD34, CD117, HLA-DR, CD33 and CD13 and negativity for CD19, CD10, CD15 and CD7.. c) Course of Hemoglobin, white blood cells (WBC), absolute neutrophils counts (ANC) and platelets during patient follow up. Recombinant erythropoietin was administered at the times indicated by solid arrows. Dashed arrow shows initiation of 5-azacytidine.
case_images: mjhid-9-1-e2017066f1.jpg
case_images: PMC5667532_01_mjhid-9-1-e2017066f1.jpg
case_images: f1-mjhid-9-1-e2017066
case_images: The blood film showed dimorphic red cells, and hypogranular neutrophils with ringed nuclei (Figure 1a) and the bone marrow aspirate was consistent with refractory anaemia with multilineage dysplasia, and 40% ringed sideroblasts (RCMD-RS). Peripheral blood smear showed 9% blasts, and immunophenotypic analysis by 4-color flow cytometry demonstrated a CD45low population with typical myeloblast phenotype, positive for CD34, CD117, CD33, HLA-DR and CD13, and negative for CD15, CD19, CD10, CD56, CD7 and CD61 (Figure 1b). A new cytogenetic study was pursued and, unexpectedly, revealed a regular 46, XY[30] karyotype and normal FISH findings (Supplemental Figure S1), whereas his mutational profile remained unchanged. The course of the patient's CBC is shown in Figure 1c.