Multiple myeloma and chronic myelogenous leukemia: a case report with literature review

This is the case of a 71 year old male who developed multiple myeloma (MM) and chronic myelogenous leukemia (CML) within a two year period. The patient initially presented with osteolytic lesions of the lumbar spine, and following the initial work-up a diagnosis of multiple myeloma with an IgG kappa paraproteinemia was made and appropriate treatment was given. Two years later the patient developed a progressively worsening leukocytosis which was found to be due to Philadelphia Chromosome (Ph1) positive CML. The occurrence in the same patient of two distinct hematologic malignancies suggests a neoplastic transformation of a pluripotent stem cell. A review of the literature appears to support the existence of a relationship between MM and CML as well as a relationship between MM and the myeloproliferative disorders.

Differential leukocyte count: manual or automated, what should it be?

Today's automated hematology analyzers capable of performing a full CBC and a differential leukocyte count (DLC) on whole blood, particularly in a closed tube system, using cytochemistry or impedance-based flow cytometry technology coupled with laser light scattering, conductivity and/or differential cell lysis, are here to stay. Their need and popularity among at least the large, cost and quality-conscious clinical laboratories have been growing for the past few years and will continue to do so in the years ahead. The efficiency and reliability of several of these analyzers in performing complete CBCD (CBC and DLC) and in flagging significant abnormalities have been tested and found acceptable with the need to review a stained blood smear or perform a manual DLC to confirm or obtain additional information on selected cases.