LEUKEMIA
LEUKEMIA
Leukemia
Leukaemias are diseases in whichabnormal proliferation ofhaemopoietic cells causesprogressively increasinginfiltration of the bone marrow
Learning outcomes
Define and Classify Leukemia
Classify Acute Myeloid leukemia by using revisedFAB classification
Discuss the etiology, pathogenesis , clinicalmanifestation, blood and bone marrow morphology
of ALL,AML,CLL,CML.
LEUKEMIA
Acute Leukemia
Acute lymphoblastic leukemia (ALL)
Acute Myeloid Leukemia (AML)
Chronic Leukemia
Chronic lymphocytic leukemia(CLL)
Chronic Myeloid leukemia (CML)
Blood picture of Acute Leukemia
Total WBCs count ranges betweensubnormal to markedly elevated values
The majority >20% of leucocytes are
blast cellsLymphoblasts with condensed nuclear chromatin,
small nucleoli, and scant agranular cytoplasm
Blood picture of Acute Leukemia
Anaemia normochromic normocyticcharacteristically progressive and severe withanisocytosis and poikilocytic, sometimes withmild polychromasia
Thrombocytopenia is also extremely common,
often being severe, with platelet counts well below
BLAST
The very basic morphological features of typicalmyeloblasts, lymphoblasts, and monoblasts are similar
The most life saving thing you can learn today ishow to recognize a blast!Large cells -10 and 18 µm
Round or oval HUGE NUCLEUS
Prominent NUCLEOLI (stain LIGHTER not DARKER than the
rest of the nucleus )
Basophilic cytoplasm
Vacuolation of both cytoplasm and nucleus
Acute lymphoblastic leukemia (ALL)
Lymphoblasts with condensed nuclear chromatin, smallnucleoli, and scant agranular cytoplasm
Blood picture of Acute lymphoblasticleukemia (ALL)
Total WBCs count ranges between
markedly elevated increased
The majority >20% of leucocytes areLymphoblasts with condensed nuclear chromatin,
small nucleoli, and scant agranular cytoplasm
Bone marrow aspirate shows neoplastic promyelocyteswith abnormally coarse and numerous azurophilic granules.Other characteristic findings include cell that containsmultiple needle-like Auer rods
Acute myeloid leukemia (AML) FAB M3
Auer ‘s rod
1. Describe the morphology of the cells in the blood smear.
2. 2. State the diagnosis consistent with the above blood picture.
Blood picture of Acute myeloid leukemia (AML)
Auer ‘s rod
Auer ‘s rod
Blood picture of Acute myeloid leukemia(AML) FAB M3
Blood picture of Acute Myeloid leukemia(AML) FAB M3
Total WBCs count ranges between
markedly elevated increased
The majority >20% of leucocytes arepromyelocytes with abnormally coarse andnumerous azurophilic granules and prominentnucleoli. Some promyeloblasts contain multipleneedle-like Auer rods
Lab featuresOther lab features :
NAP(neutrophil alkaline phophtase activityscore) reduced
Serum B12 and transcobalamin increased
Serum uric acid increased
Lactate dehydrogenase increased
Cytogenetic : Philadelphia chromosomet(9,22)
Chronic Myeloid leukemia (CML)
Peripheral blood smear shows marked leucocytosis with thepresence of whole spectrum of myeloid cells including manymature neutrophils, some metamyelocytes, and a myelocyteand basophilia
Peripheral blood film
Anaemia
Leukocytosis (usu >25 x 109/L, freq> 100 x109/L
WBC differential shows granulocytes in allstages of maturation
Basophilia
thrombocytosis
Chronic Myeloid leukemia (CML)
Chronic Lymphocytic leukemia (CLL)SMUDGE CELLS
large numbers of small round lymphocytes with scantcytoplasm and smudge cells (disrupted cells )andspherocytes
Nucleated RBC
spherocytes
Chronic Lymphocytic Leukemia (CLL)Blood picturesperipheral blood smear shows increasedsmall lymphocytes condensed chromatinand scant cytoplasm
A characteristic finding is the presence ofdisrupted tumor cells (smudge cells) andthe presence of spherocytes(hyperchromatic, round erythrocytes)
A nucleated erythroid cell is present
•peripheral lymphocytosis (>200,000)
•increased susceptibility to bacterialinfection (most frequent cause of death)
•may associated with autoimmunehemolytic anemia
Chronic Lymphocytic Leukemia (CLL)
Neutrohil leucocytosis in severe
infection :
Increase in total count &presence of
of immature cells known as SHIFT
TO THE LEFT
more marked than usual
LEUKEMOID BLOOD PICTURE
many immature granulocytes appear in the
blood simulating a leukemia
(leukemoid reaction)
Leukemoid Reaction
Marked increase in neutrophils. >50,000 x109
Shift to left immature forms.Severe infection, trauma, bone marrow infiltrationLooks like leukemia*(no blasts)
1. Describe the morphology of the cell (pointed with arrow) in the photomicrographprovided. Name the cell.
A photomicrograph of a tissue section of an enlarged lymph node obtained from51 years old man is provided