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