introductio to leukemia , type of leukemia ,, and symtoms of leukemia , ect ... detail and explanation inside slides ... thanks for all ...

1. 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.
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2.  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%
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3. -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.
White Blood Cells Disorders 3

4. 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.
 Laboratory Profile:
 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.
 Laboratory Profile:
 Normochromic normocytic anemia.
 NRBCs are found.
 The WBC count could be:
o Very high.
White Blood Cells Disorders 4

5. 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.
White Blood Cells Disorders 5

6. 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.
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7. 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.
White Blood Cells Disorders 7