Markedly Left Shifted Granulopoiesis

Related Cases: HP-271; HP-288

  • Usually due to GM-CSF (Neupogen) treatment effects; may be caused by infection

  • Morphologic features of normal promyelocytes, compared to leukemic blasts:

    • Larger size
    • Eccentric and indented nuclei
    • Less delicate chromatin
    • Inconspicuous nucleolus
    • More abundant cytoplasm
    • Perinuclear hof
    • No Auer rods
  • Strategies to distinguish markedly left-shifted marrow from acute myeloid leukemia :

    • To recognize the typical morphology of promyelocytes
    • To check history, particularly recent Neupogen treatment
    • To get the previous marrow biopsy and compare
    • Flow cytometry for any aberrant expression
    • Cytogenetics/FISH for any persistent genetic alterations
    • Chimerism studies if patient has stem cell transplant
    • Follow-up marrow biopsy

Last updated: 05/14/2015