leukemia

Blood Film Examination
(Part Five)
White Blood Cells Disorders
Definition of Leukemia:
 Abnormal neoplastic accumulation of blood cells in
BM, organs, & PB.
Clinical Classifications:
 Acute Leukemia:
 Usually fatal within 3 months.
 Characterized by the predominance of blasts of the
cell type involved.
 Subacute leukemia:
 Have a longer patient survival of 3-12 months.
 Usually have a clinical picture of acute leukemia.
 Chronic Leukemia:
 Have a survival of > one year.
 Blasts are elevated but are usually less than 5%.
 Maturation within a cell line still occurs.
Leukocyte Maturation:
 The morphology of leukocyte maturation is important
to know for differentiating cells of each maturation
stage.
 The maturation stages of granulocytes are: myeloblast,
promyelocyte, myelocyte, metamyelocyte, neutrophil
band, segmented neutrophil.
 The maturation stages of monocytes: monoblast,
promonocyte, monocyte.
White Blood Cells Disorders 1

 The maturation stages of lymphocytes are:
lymphoblast, prolymphocyte, lymphocyte
Morphology of Granulocyte Maturation
Type of
Cell
Nucleus Cytoplasm Nuclear/
Cytoplas-mic
Ratio
N/C
Normal
Range in
Peripheral
Blood
Myeloblast -Round.
-Centralized.
-Smooth chromatin
-2-5 nucleoli.
-Deep
basophilic.
-No granules.
4:1 None
Pro-
Myelocyte
-Variable shape.
-Centralized.
-Chromatin begins
to condense.
-Nucleoli are still
visible.
-Basophilic.
-Many
azurophilic
granules.
2:1 None
Myelocyte -Round or
elongated.
-Often eccentric.
-Slightly condensed.
chromatin.
-Faint nucleoli.
-Mixture of
basophilic and
eosinophilic.
- Basophilic or
eosinophilic
granules.
1:1 None
Meta-
Myelocyte
-Kidney-shaped.
-Slightly condensed
chromatin.
-No nucleoli.
-Beige or
salmon.
-Many
granules.
1:1 None
Band -Uniform or
elongated.
-U-shaped.
-Condensed
chromatin.
-No nucleoli.
-Beige or
salmon.
-Faint granules.
1:1 – 1:2 0% - 6%
Segmented
Neutrophil
-Nucleus with 2-4
lobes.
-Highly condensed
chromatin.
-No nucleoli.
-Beige or
salmon.
-Faint granules.
1:2 50% - 75%
Eosinophil -2-3 lobes.
-Condensed
chromatin.
-No nucleoli.
-Beige or
salmon.
-Many large,
round, orange
granules.
1:2 0% - 4%
Basophil -2-3 lobes.
-Condensed
chromatin.
-Beige or
salmon.
-Many large,
1:2 0% - 2%

-No nucleoli. round, purple
granules.
The Most Common Types of Leukemia:
Chronic Myelogenous Leukemia (CML):
 Occurs mainly in middle-aged adults with a slow and
unrevealing onset of symptoms.
 A characteristic differential count showing complete
maturation of granulocytes from myeloblasts to
segmented neutrophils with the majority being
myelocytes and segmented neutrophils.
 Laboratory Profile:
 WBC count usually higher than 50 X 109/L and
possibly as high as 300 X 109/L.
 Myeloblasts are less than 10%.
 Basophilia, Eosinophilia, Monocytosis.
 Normochromic normocytic anemia due to
decreased RBC production.
 Thrombocytosis in the early phases of the disease
and thrombocytopenia in the late phases.
 NRBCs are common.
Acute Myelogenous Leukemia (AML):
 A disease of childhood.
 WBC count is around 200 X 109/L.
 AML represents seven subtypes (M1 to M7) and each
type has its characteristic features.

Chronic Lymphocytic Leukemia (CLL):
 A slowly progressing malignancy and is commonly
discovered incidentally or only in the late stages of the
disease.
 Most commonly seen in adults with a mean age of
occurrence at 55 years.
 It is twice as common in men as compared with women.
 leukocytosis ranging from 10-150 X 109/L with 80%
to 90% lymphocytes.
 Smudge cells are commonly found.
 < 10% immature lymphocytes.
 Lymphocytes have a characteristic morphology:
o The nuclear chromatin is coarsely condensed.
o Nucleoli may be seen.
o Lymphocytes show minimal size and shape
variation.
o The cytoplasm is small to moderate in amount.
Acute Lymphocytic Leukemia (ALL):
 A rapidly progressing malignancy with the predominance of
immature lymphocytes.
 Mainly a disease of childhood, with a peak incidence at 4 years.
The second peak of incidence is in young adults between 20 and
40 years.
 Onset of leukemia is sudden, with symptoms of anemia,
bleeding, fever and fatigue.
 Normochromic normocytic anemia.
 NRBCs are found.
 The WBC count could be:
o Very high.

o Slighlty elevated.
o Most often normal or decreased.
 The predominant cell is the lymphoblast.
 The serum level of uric acid is often elevated.
Other White Blood Cell Disorders:
Physiologic Leukocytosis:
 It is produced by factors that do not involve tissue damage:
 Excessive exercise.
 Hypoxia.
 Stress.
Leukomoid Reaction:
 A non leukemic leukocytosis with a WBC count > 30 X 109/L.
 It is characterized by the lack of myeloblasts in PB.
 A shift to the left with increased band forms, few
metamyelocytes, & myelocytes in PB.
 The LAP score level is increased, which is a distinguishing
factor as compared with leukemia.
 Leukomoid reactions are most commonly encountered in
children with:
 Infections: pneumonia, meningitis and tuberculosis.
 Severe hemolysis.
 Metastatic cancer.
Miscellaneous Disorders and Conditions:
Neutrophilia with a Shift to the Left:
 Bacterial infections.
 Febrile illnesses.
 Tissue destruction: burns, fractures, myocardial infarctions and surgery.
Eosinophilia and Basophilia:
 Allergic diseases.
 Parasitic infections.

Monocytosis:
 Brucellosis.
 During the recovery phase of infections.
Lymphocytosis:
 Viral infections.
Congenital and Acquired Disorders of
Neutrophils:
Toxic Granulation:
 Most commonly found in severe infections or other toxic
conditions.
 Appears as tiny, dark blue-to-purple cytoplasmic granules in
the metamyelocyte, band, or segmented neutrophil stages.
Cytoplasmic Vacuoles:
 Cytoplasmic vacuoles are also signs of toxic changes.
Hereditary Hypersegmentation:
 A disorder in which the majority of the neutrophils have four
or more lobes.
 This disorder must be differentiated from the
hypersegmentation of megaloblastic anemia.

Examples on Reporting Blood Film Examination
Patient A:
Normocytic red blood cells with slight hypochromia.
Leukocyte count is slightly increased with a shift to the left.
Basophilia and many immature cells found.
Platelet count is decreased.
Follow up and further hematological investigations are
recommended.
Patient B:
Microcytic hypochromic red cells.
Marked lymphocytosis.
Undifferentiated cells seen.
Platelets appear normal.
Follow up and further hematological investigations are
recommended.

leukemia

More Related Content

What's hot (20)

Similar to leukemia (20)

Recently uploaded (20)

leukemia