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A 40-year-old woman with a history of non-Hodgkin's lymphoma reported to her physician for follow-up testing. Her CBC was normal, including a WBC count of 11,000/^L. Morphological studies on a bone marrow biopsy and a bone marrow aspirate revealed several small aggregates of mature and immature lymphocytes. Flow cytometry studies were difficult to interpret as there were too few B cells in the bone marrow aspirate specimen. No chromosomal abnormalities were detected by cyto-genetics. A bone marrow aspirate tube was also sent for molecular analysis; namely, immunoglobulin heavy chain gene rearrangement and t(14;18) gene translocation analysis by PCR. The immunoglobulin heavy chain gene rearrangement results are shown in lane 4 of the gel image below:

■ Immmunoglobulin heavy chain gene rearrangement results (left): lane 1, molecular weight marker; lanes 2 to 4, patient specimens; lane 5, positive control; lane 6, sensitivity; lane 7, negative control; lane 8, reagent blank. t(14;18) gene translocation test (right): lane 1, molecular weight marker; lanes 2 to 6, patient specimens; lane 7, positive control; lane 8, sensitivity; lane 9, negative control.

■ Immmunoglobulin heavy chain gene rearrangement results (left): lane 1, molecular weight marker; lanes 2 to 4, patient specimens; lane 5, positive control; lane 6, sensitivity; lane 7, negative control; lane 8, reagent blank. t(14;18) gene translocation test (right): lane 1, molecular weight marker; lanes 2 to 6, patient specimens; lane 7, positive control; lane 8, sensitivity; lane 9, negative control.

A 54-year-old woman with thrombosis, a high platelet count (900,000/^L), and a decreased erythrocyte sedimentation rate was tested for polycythemia vera. Megakaryocyte clusters and pyknotic nuclear clusters were observed in a bone marrow biopsy. Overall cellularity was decreased.

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