Objectives: To evaluate the value of neutrophil left shift parameters and neutrophil morphologic changes in diagnosing acute bacterial infections. Materials and Methods: Peripheral blood samples were obtained from 105 patients who had a positive culture for bacteria. Automated complete white blood cell count was performed as well as peripheral blood smear preparation. Absolute neutrophil count (ANC) and neutrophil band count were determined and the neutrophils were evaluated for morphologic changes, namely toxic granulation, vacuolation and Döhle bodies. Results: Band count was less sensitive than ANC and white blood cell count in predicting bacterial infections except in the elderly and infant population. Toxic granulation in neutrophils appeared to be as sensitive as ANC in predicting bacterial infection. Conclusion: ANC and toxic granulation appear to be more sensitive than band count in predicting bacterial infections. However, band count has a greater sensitivity in infants and elderly patients.

LA Al-Gwaiz, Bone Marrow Necrosis. 1997; 17(3): 374-376 Patchy and focal bone marrow necrosis (BMN) is a relatively common finding in routine bone marrow (BM) biopsy specimens, 2 however, severe BMN is rarely diagnosed in living patients and is more frequently diagnosed in autopsy BM.2-4 BMN has been described in a variety of neoplastic and non-neoplastic diseases. 2,3,[5][6][7][8][9][10] This is a retrospective analysis of consecutive BMN biopsies received over the last five years to assess the incidence of BMN in antemortem biopsies and the diseases associated with it. Materials and MethodsThe bone marrow trephine biopsies received between June 1991 and May 1996 at the Hematology Section, Department of Pathology at King Khalid University Hospital, Riyadh, Saudi Arabia, were retrospectively reviewed. The biopsies were obtained from the posterior iliac spine with a Jamshidi needle and stained with hematoxylin and eosin stain. The biopsies were evaluated for the presence of necrosis. Giemsa-stained BM aspirates obtained from the cases with necrosis were also assessed for evidence of necrosis, e.g., the presence of necrotic cells and necrotic eosinophilic materials for correlation with the biopsy findings.The records of patients with BMN were reviewed for age, sex, diagnosis and the clinical and laboratory features.

Ascites is not an uncommon manifestation of certain solid tumors like gastrointestinal malignancies, ovarian cancer and breast cancer. However, it is unusual to encounter ascites in patients with hematological malignancies especially chronic leukemia. The patient described here presented with massive ascites and blood lymphocytosis. Further studies confirmed the diagnosis of chronic lymphocytic leukemia with ascites. The ascitic fluid was exudative, consisting of maturelooking B-lymphocytes, which were morphologically and immunophenotypically similar to peripheral blood and bone marrow cells. The patient was treated with chemotherapy and achieved a good response and diminution of ascitic fluid accumulation.

Background:The clinical features of acute myeloblastic leukemia (AML) and its response to therapy in adult patients in Saudi Arabia are not well defined, as only scanty data has been available. This situation will likely continue unless experience with AML is reported from different institutions in the Kingdom. Patients and Methods: In this retrospective study, the records of 52 adult patients with previously untreated de novo acute myeloblastic leukemia (AML) who were treated at King Khalid University Hospital over a five-year period from January 1989 to December 1993 according to the conventional "3+7" regimen were reviewed. The clinical features of the disease, response to therapy and treatment-related complications were identified. Results: There were 33 males and 19 females with a mean age of 30±13 years (mean±SD). M 4 and M 5 AML were the predominant French-American-British (FAB) subtypes encountered. Sixty-five percent of patients achieved complete remission (CR). The median duration of the first CR of all analyzable patients was 32 weeks. The median CR duration and survival of patients achieving complete remission who survived through their consolidation treatment was 36 and 49 weeks, respectively. Conclusion: Both median duration of the first complete remission and survival compare unfavorably with those reported in the literature despite a comparable remission rate. Infectious complications were frequent and accounted for a significant number of mortalities.

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