<AML, M6(erythremic myelosis or Diguglielmo disease-remission ciretria>
Dear Sir
I am a clinical pathologist working for Dankook University Hospital.
I would like to have a good opinion for a bone marrow study case.
The patient is a 27 year old woman whose bone marrow study shows
hypercellular marrow and most of cells composed of erythroid precursor
cells, predominently pronormoblasts. Followings are detail.
M:E ratio is about 0.043:1(1:22.7).
Erythroblasts are increased and counted upto 86.2 % of ANC.
Pronormoblasts predominates(about 38.6 % of ANC).
Granulopoisis is markedly decreased(5.6%).
Nonerythroid blasts are not increased, and they are
counted about 0.8% of NEC.
Megakarycytes are hardly observed.
Dyserythropoietic changes are also observed.
In the biopsy section, cellularity is about 95% and marrow space is
almostly packed with erythroblasts.
So, We diagnosed it as AML, M6(Erythremic myelosis type).
After induction chemotherapy, second BM study shows 6% of
pronormoblast, 1.5:1 of ME ratio, 20 % of cellularity, and focal
erythoid precusors clusters in biopsy specimen.
Generally, the focus in the remission criteria of AML is myeloblast
count.
But this bone marrow is richly occupied by erythriod series not
associated with a myeloblast component.
What I want to know is the remission criteria of erythremic myelosis.
Please let me know if you have a good opinion on my case.
Sincerely.
from JongWan Kim, MD. (wan1…@hitel.kol.co.kr)