Medical Record – Bone Marrow Studyafter Chemotherapy
CLINICALNOTE: The patient is a 2-year-old boy with an abdominalneuroblastoma that has been undergoing veryaggressive therapy since September 2010. The patient has hadseveral laparotomies and one course of intraoperative radiotherapy and is currently beingstrongly considered for bone marrow transplant again at Universityof California, San Francisco (UCSF). Bone marrow aspirate is beingdone to rule out the appearance of any occult neuroblastoma in his bone marrow.
LABORATORY:CBC done on the day before the procedure,10/25/xx, revealed a white count of 28,900, hemoglobin 8.4,hematocrit 27.8, platelets 45,000 with a differential of 80% segs,2.2% lymphocytes, 15% monocytes. It should be noted that thepatient had just finished a course of GCSFand this accounts for the leukocytosis.
WRIGHT STAIN BONE MARROW: Wright stains ofthe bone marrow aspirate obtained from both the right and leftposterior iliac crest revealed a very cellular specimen that isvery active and indicative of recovery marrow. All cell lines arepresent and there is normal differentiation of all cell lines, butthere is an increased percentage of monocytes and promyelocytesseen in the marrow. Extensive review of the marrow from both theright and left side, looking at several slides, fails to reveal anyobvious neuroblastoma rosettes or tumor clumps.
A 200-cell differential isas follows: Blasts 2%, lymphocytes 8%, monocytes 16.5%,megakaryocytes 0.5%, preerythroblasts 6.5%, basophilic normoblasts 6.5%, polychromatophilic normoblasts 18%, orthochromatophilic normoblasts 1.5%, promyelocytes 9%,myelocytes 14%, metamyelocytes 6%, bands 7.5%, segmentedneutrophils 4.5%.
DIAGNOSTIC IMPRESSION: This isan m-1 active marrow, demonstrating recovery from recentmyelosuppression and the effect of GCSFwith no evidence of malignancy.
ADDENDUM: It should be noted that 8 cc of heparinizedmarrow were sent to Dr. Seeger’s Lab at Children’s Hospital in LosAngeles for monoclonal antibody assessment to seek any occultneuroblastoma.
Questions
1. What was the doctor’s conclusion regarding thebone marrow study? Explain your answer thoroughly!!!
