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Raquel Madera Pajín

Servicio de Farmacia Hospitalaria. Hospital del Oriente de Asturias Francisco Grande Covián.

Thursday, 30 April 2020

WORSENING OF PATIENT WITH ESSENTIAL THROMBOCYTHEMIA

Written by Pedro J. Espinosa Prados | Raquel Madera Pajín | Alejandro Vega Junco

AGUDIZACIÓN EN PACIENTE CON TROMBOCITEMIA ESENCIAL
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.