2017 Volume 66 Issue 6 Pages 715-720
Plasma cell leukemia (PCL) characterized by a large proportion of plasma cells in the peripheral blood is found at a low frequency in plasma cell neoplasms (PCNs). PCL is an aggressive and refractory disease, so that early diagnosis is important to improve treatment outcome. Here, we report that following an inconclusive result obtained using an automated hematological analyzer, leukocyte classification by microscopic examination was helpful in the early diagnosis of PCL. The patient was a 75-year-old man admitted to our hospital with suspicion of acute renal failure and acute heart failure. Leukocyte classification of peripheral blood using an automated hematological analyzer was not possible because of scatter results. Therefore, we performed leukocyte classification by microscopic examination. Forty-two percent of myeloma cells were observed to have unevenly distributed axle-like nuclei in the smear preparation of peripheral blood. On the basis of these findings of the smear preparation, bone marrow examination was performed on the same day. As a result, the diagnosis of myeloma cells was confirmed. Also, in the subsequent additional inspection, M-bows composed of anti-IgG, anti-lambda, and anti-Bence Jones protein antibodies were detected by immunoelectrophoresis. These findings supported the diagnosis of PCL, and chemotherapy was started. In the case of abnormal patterns of leukocyte classification obtained using an automated hematological analyzer, rapid confirmation by microscopic examination is important.
