Authors: Rachel Vanderschelden, MD; Nathanael Bailey, MD
Clinical History
The patient is a man in his early 60s with a past medical history of essential thrombocythemia, diagnosed on bone marrow biopsy 20 years prior, at age 42. He had been treated with anagrelide and aspirin without complications. The patient presented to his hematologist for routine bloodwork; and was found to have mildly elevated white blood cell count of 11.1, with a differential showing 2% blasts, 4% myelocytes, and 4% metamyelocytes. Additionally, he had an LDH of 679 IU/L (normal: <171 IU/L).
Peripheral smear demonstrated the following:
A bone marrow biopsy was performed, which demonstrated the following: