When Good Cells Go Bad: Acute Leukemia Diagnosis in the ER

According to my ER veterinarian husband, one of the benefits of being married to a clinical pathologist is you get free fly-by cyto reads. 🙃

He's working overnights in the ER this week. It's about 9 PM and I'm just settling in to binge watch Sex and the City when he sends me a text.

He says there's a 2 year old dog that came in with a week-long history of lethargy and inappetence. 

No significant findings on radiographs. 

But the CBC...

Ummm...

That's not normal...

The big question here is what is the actual cell type making up that monocyte count? Are they actually monocytes?

Time for a blood smear.

Oy. 

Yea, those aren't monocytes. Those are blasts. 😲

The fact that this pup has 127,000+ blasts in circulation leads us to a very confident diagnosis of acute leukemia. 

Acute leukemia comes in two flavors: acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML). 

The thing is, lymphoblasts and myeloblasts will look the same cytologically. So, in cases like this, we just can say it's acute leukemia from the smear.

But either way, it's very very bad news bears. 

Sad case, beautiful cytology (I'm thinking this should be the new official motto for the college of veterinary pathology?).