A-170 CBC Results, flags and scattergram using BC 6800Plus Hematology Analyzer, for a case of Burkitt*s lymphoma in leukemic phase

Abstract Background Burkitt*s lymphoma accounts for about 40% of non-Hodgkin*s lymphomas during childhood, it´s a highly aggressive mature B-cell disease. There are three clinical variants 1) endemic, which occurs in children in equatorial Africa, related to Epstein-Barr virus (EBV) or malaria infections; 2) sporadic, which affects children and young adults, with no defined geographical distribution, frequent in the West; 3) associated with immunodeficiency mainly in HIV-infected patients, also described in solid organ transplant recipients. Malignancy is linked to the rapid cell replication capacity. Tumor lysis with renal failure is a frequent complication. Sporadic variant has a higher frequency of presentation with leukemic characteristics and medullar involvement. At hematology laboratory, our Mindray BC-6800Plus instrument performs around 600 hemograms per day, where the case of a patient with Burkitt*s lymphoma in leukemic phase was evaluated. Methods Female patient, 4 years old, referred from Cajamarca, Perú. Time of illness, 1 month, with intermittent post prandial abdominal pain associated with constipation, pain in lower limbs. An ultrasound reported the presence of abdominal tumor from the right flank and across middle line. A whole blood sample was obtained in EDTA K2 tube, CBC and leukocyte differential were analyzed by the Mindray BC-6800Plus analyzer. Peripheral blood smears were prepared and evaluated as well. Results CBC count showed RBCs at 3.98×1012/L; hemoglobin: 107 g/l; hematocrit: 31.8%; MCV 79.9 fl; MCH 26.8 pg; MCHC 336 g/l; RDW-CV 12.6%; RDW-SD 37.5 fl; platelets 49×109/l; PWV 9.7 fl; WBC: 13.22×109/L; lymphocytes 61.7%; monocytes 6.1%; eosinophils 2.8%; basophils 0.3%; neutrophils 22.5%; reticulocytes 0.31%; NRBC 0.38/100 leukocytes; HFC (high fluorescence cells) 12.3%; HFC 1.62×109/L; IMG (immature granulocytes) 6.6%. Analyzer alarms were blasts, abnormal lymphocytes/blasts, immature granulocytes, atypical lymphocytes, lymphocytosis and thrombocytopenia. Leukocyte scattergram showed a high-fluorescence population over the lymphocyte area and close to monocytes. Review of peripheral smear showed a marked decrease in platelets, presence of medium-sized lymphocytes with intensely basophilic cytoplasm with vacuoles, intermediate to immature chromatin nuclei and some with nucleoli. Conclusion There is a challenge in most hematology laboratories in diagnosing sporadic variant Burkitt*s lymphoma in leukemic phase, hematology analyzer information provided by the MIindray BC-6800Plus and its alarms are valuable and a promising tools for assisting in the diagnosis, coupled with the identification of cellular characteristics and clinical presentation of the patient highlights their utility in directing the evaluation and diagnostic protocol in this group of neoplasms, improving patient safety and quality care by laboratory, which in this case enable early and accurate screening.