(1/8) The many faces of APL:

This is a challenging/educational case shared with us last week by @SaWangMD

Below in the plot, on CD45 and SCC no apparent blasts population is identified (red circle)

#hemepath #PathTwitter @LeukemiaMDA @KirillLyapichev @sanamloghavi https://twitter.com/SibaElHussein/status/1336376501802061826
(2/8) However, on CD117 and SSC, a large CD117 + population is detected (red circle)

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(3/8) Gating on the CD117+ population, it is CD34 - and HLA-DR-

#hemepath #PathTwitter
(3/8) Gating on the CD117+ population, it is CD34 - and HLA-DR- #hemepath #PathTwitter
(3/8) Gating on the CD117+ population, it is CD34 - and HLA-DR- #hemepath #PathTwitter
(3/8) Gating on the CD117+ population, it is CD34 - and HLA-DR- #hemepath #PathTwitter
(4/8) In addition it is CD11a- and CD18-, all typical of APL

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(5/8) The tricky feature in this case is that the APL population falls within the granulocytic area on CD45 and SCC (red circle), and could thus be easily missed

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(6/8) Going back and analyzing the granulocytic gate, a distinct APL population that is CD15- and CD117+ is detected (yellow arrow, typical APL) vs CD15+ granulocytes (blue arrow)

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(7/8) In addition, this APL population is CD33+ (yellow arrow) vs CD33- granulocytes (blue arrow)

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(8/8) Lessons from this case:

1) APL comes in different shapes and flavors, a high index of suspicion and proper gating could save the case

2) Don't miss out tomorrow's bone marrow session for similar highly educational cases 🩸🔬

#hemepath #PathTwitter
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