The 2016 WHO versus 2008 WHO Criteria for the Diagnosis of Chronic Myelomonocytic Leukemia

The 2016 WHO diagnostic criteria for chronic myelomonocytic leukemia (CMML) require both absolute and relative monocytosis (≥1×10⁹/L and ≥10% of white blood cell counts) in peripheral blood. Moreover, myeloproliferative neoplasm (MPN) features in bone marrow and/or MPN-associated mutations tend to support MPN with monocytosis rather than CMML. We assessed the impact of the 2016 WHO criteria on CMML diagnosis, compared with the 2008 WHO criteria, through a retrospective review of the medical records of 38 CMML patients diagnosed according to the 2008 WHO classification. Application of the 2016 WHO criteria resulted in the exclusion of three (8%) patients who did not fulfill the relative monocytosis criterion and eight (21%) patients with an MPN-associated mutation. These 11 patients formed the 2016 WHO others group; the remaining 27 formed the 2016 WHO CMML group. The significant difference in the platelet count and monocyte percentage between the two groups indicated that the 2016 WHO criteria lead to a more homogenous and improved definition of CMML compared with the 2008 WHO criteria, which may have led to over-diagnosis of CMML. More widespread use of molecular tests and more sophisticated clinical and morphological evaluations are necessary to diagnose CMML accurately.

Differential Cell Count and CRP Level in Blood as Predictors for Middle East Respiratory Syndrome Coronavirus Infection in Acute Febrile Patients during Nosocomial Outbreak

A case-control study was performed to identify clinical predictors for Middle East respiratory syndrome coronavirus (MERS-CoV) infection among patients with acute febrile illness during the nosocomial outbreak. Patients with MERS-CoV were more likely to have monocytosis with normal white blood cell (WBC) count and lower C-reactive protein (CRP) level. Simple laboratory data such as complete blood counts (CBC) with differential count could be a useful marker for the prediction of MERS and triage at the initial presentation of acute febrile patients in outbreak setting.

Assessment of the full blood count parameters of HIV/AIDS patients in Heduru Clinic, Papua New Guinea

Abnormal haematology parameters in patients with HIV / AIDS are common. Anaemia is a frequent complication among these patients and it is usually associated with serious complications. Neutropenia and eosinophilia are common in the advanced stages of AIDS. It is therefore important to determine the haematology parameters in HIV /AIDS patients. This prospective study was carried out between July and September 2008. A total of 113 case notes of HIV / AIDS patients attending the Heduru Clinic were randomly selected. Their certified full blood count electronic results were obtained from the Haematology laboratory in Port Moresby General Hospital. Detailed re-examination of the fixed stained peripheral blood film of each patient was carried out using high-powered microscope. Gender distribution of the 113 case notes indicated 46 (41%) males and 67 (59%) females. Analysis of the data indicated high frequency of anaemia among the patients. Microcytic hypochromic anaemia was prevalence among 47.8% of the patients, macroscopic hypochromic anaemia 29.2% and normochromic normocytic anaemia 23.0%. Blood film showed presence of anisocytosis and poikilocytosis. Although only one patient had leucocytosis, leucopenia was prevalent among 20.4% of the patients; of these mild leucopenia was more frequent than moderate leucopenia. A total of 51 (45.1%) patients had Eosinophilia; of these 76.5% had mild eosinophilia, 17.6% moderate eosinophilia and 5.9% marked eosinophilia. Thrombocytopenia was observed in 21.2% and 0.9% with induced pseudothrombocytopenia. It is hoped that these findings will serve as base line for more detailed studies, and support the need to strongly advocate for routine monitoring of full blood count haematological parameters of HIV/AIDS patients in Papua New Guinean.

Childhood Chronic Myeloid Leukemia with Monocytosis.

We report two cases of chronic myeloid leukemia (CML) in childhood presenting with monocytosis. History, physical examination and laboratory findings were in favor of juvenile myelomonocytic leukemia in both the cases, but reverse transcriptase polymerase chain reaction (RT-PCR) detected b2a2 and b3a2 transcript of p210 bcr-abl protein characteristic of major BCR breakpoint. Presence of monocytosis in early childhood suggests a viral infection or JMML but a possibility of CML with monocytosis needs to be considered.