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[Overt leukemia from MDS associated with marked basophilia]
Summary
A patient with refractory anemia with excess blasts (RAEB) in transformation experienced a significant increase in basophils and histamine levels. This led to severe complications including peptic ulcers and fever, ultimately resulting in death.
Area of Science:
- Hematology
- Oncology
Background:
- A 52-year-old female patient was diagnosed with refractory anemia with excess blasts (RAEB).
- RAEB is a pre-leukemic condition that can transform into acute myeloid leukemia.
Observation:
- The patient presented with leukocytosis, marked basophilia (49.0%), and blasts (14.0%) in peripheral blood.
- Bone marrow aspiration confirmed RAEB in transformation with 30.2% blasts and 21.1% basophils.
- Peripheral basophil counts increased post-admission, correlating with significantly elevated serum histamine levels.
Findings:
- Elevated histamine levels (histaminemia) induced multiple peptic ulcers and high fever.
- The patient's condition rapidly deteriorated, leading to respiratory failure and septicemia.
- Mature peripheral basophils with metachromasia suggested a potential differentiation from the leukemic clone.
Implications:
- This case highlights a rare presentation of RAEB in transformation with severe complications due to marked basophilia and histaminemia.
- Understanding the origin of basophilia in such cases is crucial for targeted therapy.
- Further research is needed to elucidate the mechanisms underlying basophilia and its clinical impact in myeloid malignancies.