Haematology Watch




An 8 year old boy, presented to Fauji Foundation Hospital Rawalpindi with:

C/O: Fever for the last 2 months associated with malaise, fatigue, and severe bone pains.

Examination revealed generalized lymphadenopathy (Bilateral cervical and inguinal, and left axillary).

His CBC revealed WBC 4400/uL,  Hb 10 g/dL,  Hct 24%,  PLT 125000/uL,  ANC 520/uL,  ALC 3800/uL, AMC 30/uL,  Retics 2.5% and ESR was 100 mm in 1st Hr.

The peripheral blood morphology showed:


A predominantly normochromic normocytic anaemia, mild thrombocytopenia, and activated lymphocytes.

An MP test was requested which showed ‘No MP seen’.

His RA factor was negative. Serum Uric acid was 251 (200 – 416 umol/L). LDH was 560 (225 – 450 U/L).

A history of severe bone pains and activated lymphocytes made the clinician showed:



> 90% blast cells with lymphoid morphology (Fig. A), being Sudan Black B (SBB) negative (Fig. B), Periodic Acid Schiff Stain (PAS) negative, and diffusely positive for Acid Phosphatase (ACP).

The case shows a classic example of Aleukemic leukemia.