NEC.............No Evident Consensus??

[Naveen Kakkar]

Dear All
            Can someone please give your views on the NEC (Non erythroid count) in the bone marrow? Does everyone do it routinely to estimate the "real" myeloid differential or do you do it only when tackling a leukemia? The WHO blast cut offs are mentioned as "Of the NEC"). Do you do the NEC only when there is significant erythroid hyperplasia? (What is a significant percentage here?). Do we do it when we encounter borderline counts at both ends- e.g. 6-10% blasts or 88% (to distinguish between AML M1 or M2). Would you do an NEC routinely on post chemotherapy marrows while checking for remission status?

Too many questions, I know. There seems to be different practices in various centers on this. Looking for a consensus here.  

Kind regards

Naveen Kakkar
CMC, Ludhiana       

[Nikhil Patkar]

Hi Naveen

I have attached a few pages from Barbara Bain's leukemia diagnosis for marrow counts. Hope that helps your query on counts.

As far as your question on post chemotherapy bone marrow goes, do flow and molecular for AML and ALL MRD. If these facilities are not available then  classify these bone marrows as M1 (<5% blasts), M2 (5-24) and M3 (>25%). I am not very sure but I think this too would need a NEC.

Nikhil 

Naveen Kakkar
CMC, Ludhiana       

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Dr Nikhil Patkar (MD,DNB)
Hematopathology & Molecular Pathology
Post Doctoral Fellow
Hematologics Inc
Seattle, WA
USA