A-172 Graphical contribution and CBC of BC-6800Plus hematology analyzer in a case of Myelodisplastic Syndrome related to Chemotherapy and Radiotherapy

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Abstract Background Myelodysplastic syndromes (MDS) are clonal stem cell disorders characterized by ineffective hematopoiesis and dysplastic changes, leading to cytopenias such as anemia, thrombocytopenia, and neutropenia. Diagnosis is challenging due to the insidious clinical presentation. Nowadays, automated hematological analyzer could not only report complete blood counts (CBC) but also give cell population data (CPD). In this study, the Mindray BC-6800Plus analyzer was used to assess CBC and CPD, such as leukocyte differentials (DIFF) in a case of therapy-related MDS from the National Institute of Neoplastic Diseases (INEN). This rare but serious oncologic complication was diagnosed based on initial morphological alterations in CBC and DIFF reports. Methods A 73-year-old female patient from Chiclayo, diagnosed with endometrial cancer clinical stage III in September 2023, received surgical treatment at another institution, adjuvant chemotherapy by the PORTEC3 scheme, and 25 sessions of radiotherapy with a total dose of 4500 cGy in pelvic fields, along with 2 sessions of brachytherapy. A whole blood sample was collected with an EDTA K2 tube for the hematology analysis by the Mindray BC-6800Plus hematological analyzer to report complete CBC, DIFF scattergram and RET scattergram. The scattergrams were evaluated, and finally, the peripheral blood smear was reviewed manually. Results Red blood cells: 2.58 x 1012/l; hemoglobin: 91 g/l; hematocrit: 27.9%; MCV 108.1 fl; MCH 35.4 pg; MCHC 326 g/l; RDW-CV 17.3%; RDW-SD 68.7 fl; Platelets 37 x 109/l; VPM 10.9 fl; WBC: 5.38 x 109/l; Lymphocytes 35.9%; Monocytes 0.0%; Eosinophils 1.4%; Basophils 0.2%; Neutrophils 61.2%; Reticulocytes 5.79%; NRBC 0.74/100 leukocytes; no HFC (High fluorescence cells); IMG (immature granulocytes) 1.3%. Flags reported by analyzer were blasts; abnormal lymphocytes/blasts; immature granulocytes; fragments; anisocytosis; reticulocytosis and thrombocytopenia. The DIFF scattergram showed an area of cells with medium to high fluorescence and low internal complexity located to the left of the monocyte area and above lymphocytes. On the RET scattergram, an increase of fragments and immature red blood cells with intermediate to high fluorescence corresponding to reticulocytes was observed. Review of the blood smear confirmed the presence of blast cell with large size, immature chromatin, and nucleoli evidence. Conclusion Flags provided by the hematology analyzers, combined with an evaluation of the peripheral blood smear by trained personnel, allow for a morphological description of cellular abnormalities. In the present case, this contributes to the initial screening for MDS or leukemia secondary to treatment, with a poor short-term prognosis.

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