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Morphological Clues of Acute Monocytic Leukemia in COVID-19-Induced Transient Leukoerythroblastic Reaction with Monocytosis

Tam, Ingrid S. ; Elemary, Mohamed ; DeCoteau, John ; Porwit, Anna LU and Torlakovic, Emina E. (2024) In Hematology Reports 16(2). p.331-335
Abstract

Viral infections, including those caused by COVID-19, can produce striking morphologic changes in peripheral blood. Distinguishing between reactive changes and abnormal morphology of monocytes remains particularly difficult, with low consensus rates reported amongst hematopathologists. Here, we report a patient who developed transient monocytosis of 11.06 × 109/L with 32% promonocytes and 1% blasts during hospitalization that was secondary to severe COVID-19 infection. Three days later, the clinical status of the patient improved and the WBC had decreased to 8.47 × 109/L with 2.2 × 109/L monocytes. Flow cytometry studies did not reveal immunophenotypic findings specific for an overt malignant population.... (More)

Viral infections, including those caused by COVID-19, can produce striking morphologic changes in peripheral blood. Distinguishing between reactive changes and abnormal morphology of monocytes remains particularly difficult, with low consensus rates reported amongst hematopathologists. Here, we report a patient who developed transient monocytosis of 11.06 × 109/L with 32% promonocytes and 1% blasts during hospitalization that was secondary to severe COVID-19 infection. Three days later, the clinical status of the patient improved and the WBC had decreased to 8.47 × 109/L with 2.2 × 109/L monocytes. Flow cytometry studies did not reveal immunophenotypic findings specific for an overt malignant population. At no time during admission did the patient develop cytopenia(s), and she was discharged upon clinical improvement. However, the peripheral blood sample containing promonocytes was sent for molecular testing with an extended next-generation sequencing myeloid panel and was positive for pathogenic NPM1 Type A and DNMT3A R882H mutations. Subsequently, despite an essentially normal complete blood count, the patient underwent a bone marrow assessment that showed acute myeloid leukemia with 77% promonocytes. This case emphasizes the critical importance of a full work up to exclude acute leukemia when classical promonocyte morphology is encountered in the peripheral blood. Promonocytes are not a part of the reactive changes associated with COVID-19 and remain specific to myeloid neoplasia.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute myeloid leukemia, COVID-19, monocytes, promonocytes
in
Hematology Reports
volume
16
issue
2
pages
5 pages
publisher
MDPI AG
external identifiers
  • scopus:85196799637
  • pmid:38921181
ISSN
2038-8322
DOI
10.3390/hematolrep16020033
language
English
LU publication?
yes
id
57fc2b71-7848-4637-adff-628454e5cb43
date added to LUP
2024-11-07 12:03:32
date last changed
2025-06-06 05:31:43
@article{57fc2b71-7848-4637-adff-628454e5cb43,
  abstract     = {{<p>Viral infections, including those caused by COVID-19, can produce striking morphologic changes in peripheral blood. Distinguishing between reactive changes and abnormal morphology of monocytes remains particularly difficult, with low consensus rates reported amongst hematopathologists. Here, we report a patient who developed transient monocytosis of 11.06 × 10<sup>9</sup>/L with 32% promonocytes and 1% blasts during hospitalization that was secondary to severe COVID-19 infection. Three days later, the clinical status of the patient improved and the WBC had decreased to 8.47 × 10<sup>9</sup>/L with 2.2 × 10<sup>9</sup>/L monocytes. Flow cytometry studies did not reveal immunophenotypic findings specific for an overt malignant population. At no time during admission did the patient develop cytopenia(s), and she was discharged upon clinical improvement. However, the peripheral blood sample containing promonocytes was sent for molecular testing with an extended next-generation sequencing myeloid panel and was positive for pathogenic NPM1 Type A and DNMT3A R882H mutations. Subsequently, despite an essentially normal complete blood count, the patient underwent a bone marrow assessment that showed acute myeloid leukemia with 77% promonocytes. This case emphasizes the critical importance of a full work up to exclude acute leukemia when classical promonocyte morphology is encountered in the peripheral blood. Promonocytes are not a part of the reactive changes associated with COVID-19 and remain specific to myeloid neoplasia.</p>}},
  author       = {{Tam, Ingrid S. and Elemary, Mohamed and DeCoteau, John and Porwit, Anna and Torlakovic, Emina E.}},
  issn         = {{2038-8322}},
  keywords     = {{acute myeloid leukemia; COVID-19; monocytes; promonocytes}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{331--335}},
  publisher    = {{MDPI AG}},
  series       = {{Hematology Reports}},
  title        = {{Morphological Clues of Acute Monocytic Leukemia in COVID-19-Induced Transient Leukoerythroblastic Reaction with Monocytosis}},
  url          = {{http://dx.doi.org/10.3390/hematolrep16020033}},
  doi          = {{10.3390/hematolrep16020033}},
  volume       = {{16}},
  year         = {{2024}},
}