Flowers blossoming in the desert heat

Abstract

A 39-year-old man with a history of intravenous drug abuse and hepatitis C virus infection was found unresponsive on the street in Tucson, Arizona. His temperature was 41.8°C and he was tachycardic, hypotensive, and hypoxemic. A complete blood count showed white blood cell count of 17.8 3 10 9 /L, red blood cell count of 5.21 3 10 12 /L, hemoglobin level of 164 g/L, mean corpuscular volume of 97.6 fL, red cell distribution width of 13.8%, and platelet count of 386 3 10 9 /L. A urine drug screen detected opiates and amphetamines. The peripheral blood showed absolute neutrophilia with a shift to immaturity and botryoidtype hypersegmentation of the neutrophils (65% affected; panel A, original magnification 3100; Wright-Giemsa stain), monocytes (panel B, original magnification 3100; Wright-Giemsa stain), and lymphocytes. These morphologic features returned to normal 24 hours after hydration and cooling. Although neutrophil hypersegmentation can be seen in vitamin B 12 and folate deficiencies, heat shock, or amphetamine overdose, the morphologic features differ depending on the underlying cause. In nutritional deficiencies, the number of segments is increased up to 5, 6, and rarely 7. Conversely, in heat shock and amphetamine overdose, the neutrophils, monocytes, and lymphocytes are hypersegmented up to 9 lobes emanating from a single centriole with radial segmentation: the so-called botryoid type. Leukocyte morphology and mean corpuscular volume can help differentiate the diagnosis.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org.

Profiling FLT3 Mutations in Mexican Acute Myeloid Leukemia Pediatric Patients: Impact on Overall Survival

“…Ten out of 14 FLT3 –ITD AML patients acquired new cytogenetic and structural chromosomal abnormalities, compared with seven out of 21 FLT3 wild-type AML patients. This observation has been confirmed by others analyzing FLT3 –ITD AML patients at relapse ( 47 ). Other genomic features supporting genomic instability in FLT3 –ITD patients have been shown, including microsatellite instability ( 48 , 49 ), shorter telomeres ( 50 ), and high frequency of somatic mutations ( 51 ).…”

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“…Multi-lobulation Hypersegmentation of neutrophils is defined as having more than five lobes and denotes either a megaloblastic process or, rarely in iron deficiency anemia. Patients with heat stroke may also exhibit grape-like (botryoid) numerous lobulations [16,17].…”