{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:10:12Z","timestamp":1756314612396,"version":"3.44.0"},"reference-count":33,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,2,10]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>An HIV-negative South African woman in her 50s presented to hospital with fatigue. She had no medical history and is a Jehovah\u2019s Witness. Her full blood count revealed macrocytic anaemia and severe thrombocytopenia. On smear review, there were \u00b166% blasts with no lineage discerning morphological features. Peripheral blood flow cytometry revealed a blast population that expressed B-cell (CD19 dim, cCD79a dim, CD10 dim, CD22 moderate), T\/NK-cell (CD7) and myeloid markers (HLA-DR, CD33, CD117). However, antigen combinations did not fulfil the requirements for specific lineage assignment. The bone marrow aspirate and trephine biopsy were hypercellular with diffuse involvement of blasts. Myeloperoxidase positivity was subsequently confirmed on cytochemistry and immunohistochemistry. The final diagnosis was an acute myeloid leukaemia with expression of aberrant lymphoid markers and monocytic cytochemistry. Delays in lineage assignment can derail timely induction, shake patient confidence and postpone the doctor-patient treatment discussions. This is particularly important in already vulnerable populations.<\/jats:p>","DOI":"10.1136\/bcr-2024-263201","type":"journal-article","created":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T20:05:34Z","timestamp":1740254734000},"page":"e263201","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Implications of an unusual acute leukaemia phenotype on the care of a South African Jehovah\u2019s Witness patient"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5004-2490","authenticated-orcid":false,"given":"Quintin Andre","family":"van Staden","sequence":"first","affiliation":[{"name":"Department of Haematology and Cell Biology, University of the Free State, Bloemfontein, South Africa"},{"name":"Department of Hematology and Cell Biology, Universitas Academic Hospital Laboratory, National Health Laboratory Service, Bloemfontein, Free State, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-4061","authenticated-orcid":false,"given":"Anne-Cecilia","family":"van Marle","sequence":"additional","affiliation":[{"name":"Department of Haematology and Cell Biology, University of the Free State, Bloemfontein, South Africa"},{"name":"Department of Hematology and Cell Biology, Universitas Academic Hospital Laboratory, National Health Laboratory Service, Bloemfontein, Free State, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,22]]},"reference":[{"key":"2025082709301440000_18.2.e263201.1","first-page":"2275","article-title":"The International Consensus Classification of acute leukemias of ambiguous lineage","volume":"141","author":"Weinberg","year":"2023","journal-title":"Blood"},{"key":"2025082709301440000_18.2.e263201.2","first-page":"405","article-title":"Flow cytometric immunophenotyping and comparison with immunocytochemistry in small round cell tumors","volume":"23","author":"Brahmi","year":"2001","journal-title":"Anal Quant Cytol Histol"},{"key":"2025082709301440000_18.2.e263201.3","first-page":"329","article-title":"Sensitivity and specificity analysis of the lineage related antibodies in acute leukemia immunophenotyping by flow cytometry","volume":"13","author":"Chen","year":"2005","journal-title":"Zhongguo Shi Yan Xue Ye Xue Za Zhi"},{"key":"2025082709301440000_18.2.e263201.4","doi-asserted-by":"crossref","DOI":"10.1182\/blood.V110.11.4256.4256","article-title":"Comparison of Cytochemistry, Flow Cytometry and Immunohistochemistry for the Detection of Myeloperoxidase in Acute Myeloid Leukemia","volume":"110","author":"Saravanan","year":"2007","journal-title":"Blood"},{"key":"2025082709301440000_18.2.e263201.5","doi-asserted-by":"crossref","unstructured":"Chipidza FE , Wallwork RS , Stern TA . Impact of the Doctor-Patient Relationship. Prim Care Companion CNS Disord 2015;17. doi:10.4088\/PCC.15f01840","DOI":"10.4088\/PCC.15f01840"},{"key":"2025082709301440000_18.2.e263201.6","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1111\/bjh.16284","article-title":"Treatment of acute leukaemia in adult Jehovah\u2019s Witnesses","volume":"190","author":"El Chaer","year":"2020","journal-title":"Br J Haematol"},{"key":"2025082709301440000_18.2.e263201.7","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1183\/20734735.006616","article-title":"Top tips to deal with challenging situations: doctor\u2013patient interactions","volume":"13","author":"Hardavella","year":"2017","journal-title":"Breathe (Sheff)"},{"key":"2025082709301440000_18.2.e263201.8","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqac070"},{"key":"2025082709301440000_18.2.e263201.9","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01620-2"},{"key":"2025082709301440000_18.2.e263201.10","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s12288-017-0849-1","article-title":"Comparison of Immunohistochemistry, Cytochemistry, and Flow Cytometry in AML for Myeloperoxidase Detection","volume":"34","author":"Ahuja","year":"2018","journal-title":"Indian J Hematol Blood Transfus"},{"key":"2025082709301440000_18.2.e263201.11","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1179\/1607845414Y.0000000223","article-title":"Can threshold for MPO by flow cytometry be reduced in classifying acute leukaemia? A comparison of flow cytometric and cytochemical myeloperoxidase using different flow cytometric cut-offs","volume":"20","author":"Manivannan","year":"2015","journal-title":"Hematology"},{"key":"2025082709301440000_18.2.e263201.12","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/bjh.17210","article-title":"Standardised immunophenotypic analysis of myeloperoxidase in acute leukaemia","volume":"193","author":"Bras","year":"2021","journal-title":"Br J Haematol"},{"key":"2025082709301440000_18.2.e263201.13","doi-asserted-by":"publisher","DOI":"10.1182\/BLOOD.2022015850"},{"key":"2025082709301440000_18.2.e263201.14","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1002\/jha2.887","article-title":"When acute promyelocytic leukaemia changes its face in the peripheral blood","volume":"5","author":"Le Grand","year":"2024","journal-title":"EJHaem"},{"key":"2025082709301440000_18.2.e263201.15","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/jha2.855","article-title":"Bone marrow-restricted aberrant myeloperoxidase expression in B-acute lymphoblastic leukemia: A diagnostic dilemma and mimicry of mixed phenotype acute leukemia","volume":"5","author":"Wang","year":"2024","journal-title":"EJHaem"},{"key":"2025082709301440000_18.2.e263201.16","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.htct.2020.08.012","article-title":"Precursor B-lineage acute lymphoblastic leukemia patients with aberrant natural killer cell and T cell \u2013 lineage antigen expression: experience from a tertiary cancer care center","volume":"44","author":"Bommannan","year":"2022","journal-title":"Hematol Transfus cell Ther"},{"key":"2025082709301440000_18.2.e263201.17","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.10489"},{"key":"2025082709301440000_18.2.e263201.18","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-10-0610"},{"key":"2025082709301440000_18.2.e263201.19","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1002\/cncr.32552","article-title":"Mixed-phenotype acute leukemia: A cohort and consensus research strategy from the Children\u2019s Oncology Group Acute Leukemia of Ambiguous Lineage Task Force","volume":"126","author":"Orgel","year":"2020","journal-title":"Cancer"},{"key":"2025082709301440000_18.2.e263201.20","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-07-379016"},{"key":"2025082709301440000_18.2.e263201.21","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1182\/asheducation-2016.1.339","article-title":"Fitness in the elderly: how to make decisions regarding acute myeloid leukemia induction","volume":"2016","author":"Rao","year":"2016","journal-title":"Hematology Am Soc Hematol Educ Progr"},{"key":"2025082709301440000_18.2.e263201.22","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-08-868752"},{"key":"2025082709301440000_18.2.e263201.23","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1182\/blood.V79.9.2370.2370","article-title":"Bone marrow-derived stromal cells prevent apoptotic cell death in B-lineage acute lymphoblastic leukemia","volume":"79","author":"Manabe","year":"1992","journal-title":"Blood"},{"key":"2025082709301440000_18.2.e263201.24","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2402431"},{"key":"2025082709301440000_18.2.e263201.25","doi-asserted-by":"crossref","first-page":"3437","DOI":"10.1182\/blood.V82.11.3437.3437","article-title":"Analysis of the mechanism of adhesion of precursor-B acute lymphoblastic leukemia cells to bone marrow fibroblasts","volume":"82","author":"Bradstock","year":"1993","journal-title":"Blood"},{"key":"2025082709301440000_18.2.e263201.26","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1080\/10245332.2017.1411548","article-title":"Antineoplastic chemotherapy in Jehovah\u2019s Witness patients with acute myelogenous leukemia refusing blood products - a matched pair analysis","volume":"23","author":"Wilop","year":"2018","journal-title":"Hematology"},{"key":"2025082709301440000_18.2.e263201.27","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V98.13.3584"},{"key":"2025082709301440000_18.2.e263201.28","doi-asserted-by":"crossref","first-page":"4087","DOI":"10.1200\/JCO.2004.01.144","article-title":"Autologous Stem-Cell Transplantation Can Be Performed Safely Without the Use of Blood-Product Support","volume":"22","author":"Ballen","year":"2004","journal-title":"J Clin Oncol"},{"key":"2025082709301440000_18.2.e263201.29","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines10081974","article-title":"Mixed-Phenotype Acute Leukemia: Clinical Diagnosis and Therapeutic Strategies","volume":"10","author":"George","year":"2022","journal-title":"Biomedicines"},{"key":"2025082709301440000_18.2.e263201.30","article-title":"The treatment of acute lymphoblastic leukemia in Jehovah\u2019s Witnesses and patients who cannot accept blood products","volume":"18","author":"Nguyen","year":"2022","journal-title":"Leuk Res Rep"},{"key":"2025082709301440000_18.2.e263201.31","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-01-621664"},{"key":"2025082709301440000_18.2.e263201.32","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.38.9429"},{"key":"2025082709301440000_18.2.e263201.33","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2012971"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:30:26Z","timestamp":1756312226000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,22]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2024-263201"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263201","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}