I got this right! Myeloproliferative disorder transformed to Acute Megakaryoblastic Leukaemia.
I love the training links on the UK NEQAS digital morphology website. Take a look https://www.instagram.com/haematography/, really useful for anyone involved in blood cell morphology.
I particularly found useful, the guidance on when to use the term 'Megakaryocyte fragment' and when to use the term 'Giant platelet'. Megakaryocyte fragments are basophilic, often atypical in shape, may be vacuolated and lack granules. A giant platelet however is enlarged but has very typical platelet features.
Another learning point from the case narrative was that the heavy granulation (what I would call toxic granulation) in this case, may not neccessarily be due to infection or inflammation, but yet another bizarre abnormaility. A point that I had not previously considered.
The narrative also mentions that the fragments seen are not associated with with an acute microangiopathic haemolytic anaemia (MAHA), as they are note sharp in appearance. The bizarre shaped fragments seen here are found in Dyserythropoiesis. I have personally however, seen blunt red cell fragments in TTP but I accept the bizarre shapes are not a feature of MAHA.
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