Figure 1. An image of a peripheral blood smear is presented, stained with fast panoptic, of a 92 years old patient with essential thrombocythemia (ET), JAK2 positive, diagnosed in 2008 with a score in the Dynamic International Prognosis Score System (DIPSS) of 5 (high risk).
The patient goes to the emergency with a clinical profile of tiredness, dizziness, fatigue, and abdominal pain. In the analytical highlights the presence of normochromic normocytic anemia, with thrombopenia, neutrophilic leukocytosis and a significant increase in LDH values (Hemoglobin: 8,5 g/dL, MCV: 88,8 fL, MCH: 26,3 pg, platelets: 34.000/mm3, leukocytes: 103.300/mm3, neutrophils: 71.160/mm3, LDH: 855 UI/L). Studying the blood smear showed dysplastic neutrophils with segmentation and hypodesgranulation abnormalities; 61% of medium-sized blasts, with a nucleus that may have an unclear nucleolus and sometimes a kidney-shape configuration, moderate-sparse cytoplasm, without Auer canes and myeloperoxidase positive in 2-3% of blasts. In addition, marked anisopoiquilocitosis and anisochromia were observed.