From www.bloodjournal.org by guest on July 28, 2017. For personal use only.
bloodwork
®
IMAGES
IN HEMATOLOGY
Touch imprint matters…
c Biswadip Hazarika, Gulf Medical University, Ajman, United Arab Emirates
A
40-year-old man presented with severe anemia and gum bleeding. His complete blood count showed
severe pancytopenia (hemoglobin, 67 g/L; red blood cells, 2.1 3 1012/L; white blood cells, 0.8 3 109/L;
platelets, 12 3 109/L). The peripheral blood smears revealed no blasts or atypical cells. The bone marrow
aspiration yielded a dry tap. A trephine biopsy was performed with preparation of a few touch imprints.
The touch imprints were packed with blasts (panel A), which upon cytochemical staining showed
myeloperoxidase positivity. An initial diagnosis of acute myeloid leukemia was made the same day. A week
afterward, the trephine biopsy sections were evaluated, which showed marked hyperplasia with near-total
replacement of the marrow by blasts (panel B). Immunohistochemistry confirmed the case as acute myeloid
leukemia.
Bone marrow touch imprints play a crucial role in the diagnostic workup of acute leukemia, particularly
when there is severe pancytopenia and a dry tap on aspiration. In few instances like this, the peripheral blood
may not yield the required number of cells for flow cytometry. An adequate touch imprint provides
important morphologic information to arrive at an initial diagnosis the same day while the trephine biopsy
sections are awaited. The value of touch preparation is well reported in the literature but may be overlooked
in practice.
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.
BLOOD, 4 APRIL 2013 x VOLUME 121, NUMBER 14
2585
From www.bloodjournal.org by guest on July 28, 2017. For personal use only.
2013 121: 2585
doi:10.1182/blood-2012-11-467621
Touch imprint matters…
Biswadip Hazarika
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