Notable Cases by Dr. Habib Moshref Razavi:
A 73-year-old male with a history of essential thrombocythemia, stable for several years on hydroxyurea, presented with generalized fatigue, worsening thrombocytopenia, and anemia. He had circulating blasts on peripheral smear review. Initially admitted for expedited workup, a bone marrow biopsy revealed 65% blasts, consistent with myeloid leukemic transformation.
Unsuitable for intensive treatment or bone marrow transplant, he remains inpatient for transfusion support and management, with chemotherapy (azacitidine/venetoclax) planned. Cytogenetics is complex. Flow cytometry shows 61% blasts expressing dim CD45, CD117, HLA DR, CD13, variable CD33, dim CD4, bright CD36, variable CD38, variable CD71. MPO and CD34 are not expressed. From my understanding, the transformation of MPN to blast phase, particularly erythroid leukemia, is rare. (May Grünwald and Giemsa stain x100 magnification). H&E, CD117 and e-cadherin are the last three panels respectively. View larger images on LinkedIn
