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A case study of abnormally presenting acute myelomonocytic leukemia



Acute Myeloblastic Leukemia (AML) refers to the formation of malignant bone marrow neoplasms that contain myeloid precursors of white blood cells. Acute Myeloblastic Leukemia (AML – M4) is a type of pediatric AML which is very common. Some symptoms of the disease may include dizziness, respiratory symptoms, asthenia, and fever. Other characteristics symptoms include neurological disorders, bruises, coagulation disorders, excessive bleeding as well as gingival hyperplasia.  The major diagnostic methods applied includes cytochemical aspiration of bone marrow, immunological analysis, blood analysis, and cerebrospinal fluid investigations. Chromosomal abnormalities usually characterize the Acute Myeloblastic Leukemia (AML – M4). The treatment administered to patients suffering from Acute Myeloblastic Leukemia (AML – M4) include administering intensive multidrug chemotherapy as well as selected cases of allogeneic bone marrow transplantation. 

Case Report / Patient History

The patient revealed some complications related to fatigue, and asthenia as well as persisted fever. The previous history revealed traces of breathing problems and  painful muscles. The patients were characterized by abnormal low Red Blood Cells (RBC) count; hemoglobin test revealed decreased in the number of HGB, the hematocrit test revealed a low level of  HCT. The entire patient history analysis revealed red cell deficiency. There was also decreased platelets in the blood.  The patient was found to have been diagnosed with Anemia, persisted dehydration as well as bone marrow problems. 

Laboratory Data

The laboratory data indicates that the patient had ANC count below 1,000 / ul. The number of circulating blasts in the blood cells was absent. The percentage in which lab tests indicated that they were absent was about 15%. The platelets counting in lab revealed a decrease below normal whereby less that 20, 0000/ul were counted. The blood analysis revealed that there was corresponding decrease in the flow of blood in various organs such as the liver, CNS, lungs, and skin. The white blood cells count in respective cells was less than 100 /ml. Through blood analysis, the patient revealed that normocytic and normochromic anemia was too low below the normal with a range of 3 gr/dl (Sheng-Tsung, Yen-Chuan, Li-Ping, Ching-Cherng, Shih-Sung, 2013). The thrombocyte count was found to have decreased with the range of less than 100 /ml White Blood Cells. The viewing of the blood cells using microscopy revealed that the patient had myeloblasts which had Auer rods. Their shape was characterized by having a needle-shaped, and they accumulated some myeloid granules.

The blood chemistry analysis included testing for the presence and concentration of plasma electrolytes, Creatinin, uric acid, lactate dehydrogenase (LDH), as well as Blood Urea Nitrogen (BUN). The application of Giemsa staining revealed a high concentration of myeloblasts, promonocytes, and monoblasts (Arnauld, Vassal, 2004). The testing included a specimen of bone marrow aspirate which was applied to perform tests involving cytogenetic analysis for effective and efficient detection of chromosomal abnormalities. Among the observed chromosomal abnormalities included inv(16). The examination process performed cerebrospinal (CSF) analysis which revealed that there was less than five cells /ml as well as the presence of myeloblasts (Arnauld, Vassal, 2004).

The radiology investigations were performed using X-ray tools to verify and validate the presence of pneumonia as well as signs and symptoms of cardiac diseases. Other tools applied included abdominal ultrasound for investigating about the neurological symptoms such as the central nervous system problems using the sophisticated laboratory analysis used computed tomography (Sheng-Tsung, et al. 2013). Alternatively, confirmation analysis was performed using magnetic resonance imaging (MRI)   


In the present case study, the entire analysis has indicated the presence of AML-M4 characterized by monoblasts features. The various attributes found with patient included bone marrow disorders which had hypercellular marrow. She had low WBC as well as low RBC counts. Similarly, there were severe cell function abnormalities. The result of the entire case was the easily noted symptoms which included the typical presentation of fatigue and anemia. This case study of the patient described had previously been exposed to chemotherapy. This patient has successfully treated the laboratory. However, blood tests among other diagnosis operations revealed that the patient was suffering from AML. The patient treatment was successful through allogeneic transplantation since the level of AML-M4 was severe. Transplantation is the only option for the patients diagnosed with high risks of relapse during the first remission and even after relapsing. High risks of infection for a prolonged time may not have a cure, especially for elderly patients since allogeneic transplantation cannot be performed (Arnauld, Vassal, 2004). 


The case study discussed above proves that it is always necessary to perform basic clinical checkup as well as receive treatment guidance for specific conditions. Patients should as well seek for confirmation of the diseases through various tests. About the case presented, the occurrence of acute myeloid leukemia (AML-M4) was diagnosed after chemotherapy treatment of the concerned patient. Normally in common in clinical settings it true that there are the simultaneous occurrences of acute myeloid leukemia (AML-M4) malignancies in patients who have previous been exposed to chemotherapy (Arnauld, Vassal, 2004).


Arnauld C.V., Vassal G.  (2004). Acute Myeloid Leukemia (AML-M4)

Sheng-Tsung C.,Yen-Chuan H., Li-Ping L., Ching-Cherng T., Shih-Sung C. (2013). Acute Myelomonocytic Leukemia with Abnormal Eosinophils: A Case Report with Multi-Modality Diagnostic Work-up

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in custom nursing papers if you need a similar paper you can place your order from custom nursing essay.

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