Myeloid: Leukemia

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MYELOID

ACUTE
LEUKEMIA
• Objective :To study the blood picture of Acute
myeloid leukemia.

• Definition:They are malignant neoplasm of blood


forming cells which undergo uncontrolled
proliferation in bone marrow.

• Classification:
• Acute- 1. Myeloblastic 15%
2.Lymphoblastic 35%
• Chronic- 1.Chronic Myeloid leukemia 40%
2.Chronic lymphocytic leukemia 10%
Acute leukemia
-They are characterized by predominance of undifferentiated

leucocyte precursors or leukemic blasts.

-A leukemia is acute if the bone marrow consists of more than

20% blasts.(WHO)

-Diagnosis of acute leukemia is made by a combination of

routine blood picture and bone marrow examination , coupled

with cytochemical stains and certain biochemical

investigations.
SIGNS AND SYMPTOMS

• Fatigue

• Shortness of breath on exertion

• Easy bruising

• Petechiae

• Bleeding in the nose or from the gums

• Prolonged bleeding from minor cuts

• Recurrent minor infections or poor healing of minor cuts

• Loss of appetite or weight loss

• Mild fever
SIGNS AND SYMPTOMS
• Total WBC Count between 5x109/L and 30x109/L with
myeloblasts in the peripheral blood smear
• Bone and joint pain are the first symptoms in 25% of patients.
• Elevated serum lysozyme (especially in monocytic subtypes),
Hyperuricemia (caused by increased cellular turnover),
Hyperkalemia (caused by cell breakdown),
Hyperphosphatemia, and hypocalcemia.
• Renal failure, tetany, and lethal heart arrhythmias may develop.
RISK FACTORS
•Age
Older adults are more likely to develop AML

•Smoking
20% of AML cases are linked to smoking
Doubles the risk of disease in people older than 60

•Genetic disorders
Down syndrome, Fanconi’s anemia
RISK FACTORS
•High doses of radiation
Long-term survivors of atomic bombs

•Previous chemotherapy treatment


Breast cancer, ovarian cancer, lymphoma

•Exposure to industrial chemicals


Benzene
Peripheral blood smear findings of acute leukemia

Anaemia –Normocytic Normochromic type

Leukocyte count- Variably elevated and usually it is


1lakh/cumm. However it can be less than 10,000 in some
cases where it is called Subleukemic leukemia. Majority of
the cells are monotonous blast cells containing large
vesicular nuclei and small amount of cytoplasm.

Platelet count-Almost always there is thrombocytopenia


ranging from moderate to severe.
AML- Morphologic characteristics of blast cells

Size- 10-18um
Nucleus – Round or oval
Nuclear chromatin- Fine
Cytoplasm- Scanty to moderate with fine
azurophilic granules,Auer rods may be seen.
Nucleoli- 3-5
Cytochemical stain- Peroxidase stain +ve
except in Mo type / Sudan black positive
CLINICAL OVERVIEW
Classification of AML

• FAB classification

• WHO classification
Differences between FAB and WHO

FAB-classification
1) Morphologic Findings Heavily used
2) Special staining (SBB, MPO, NSE, etc), if required

WHO-classification
1) Morphologic findings
2) Special staining (decreased role)
3) Immunophenotyping (in the form of FC and IHC) heavily
used.
4) Cytogentics and Molecular genetics studies frequently used.
FAB Classification of AML

1) M0 undifferentiated acute myelo leuk (5%)


2) M1 AML with minimal maturation (20%)
3) M2 AML with maturation (30%)
4) M3 Acute promyelocytic leukemia (5%)
5) M4 Acute myelomonocytic leukemia (20%)
6) M5 Acute monocytic leukemia (10%)
7) M6 Acute erythroid leukemia (3%)
8) M7 Acute megakaryocytic leukemia (1%)
WHO CLASSIFICATION
DIAGNOSIS
Myeloblasts Monoblasts
Generally have central nuclei with fine, Monoblasts are frequently large with abundant
uncondensed chromatin and often prominent cytoplasm, diffuse chromatin and often prominent
nucleoli (usually three to five) but have variable nucleoli.
cytoplasm and may have some cytoplasmic
granules.

Primitive myeloblasts are identified by monoclonal Monoblasts are characterized by strong reaction
antibodies against myeloid-associated antigens with Alpha-naphthyl acetate esterase (ANAE),
(MPO, CD13, CD33, CD117). Alpha-naphthyl butyrate esterase (ANBE), or
More mature myeloblasts can also be identified by antibodies including antilysozyme, CD68, CD64,
cytochemical reactions with graulocyte-associated and CD36.
enzymes using Myeloperoxidase, Sudan Black B,
and Chloroacetate esterase (CAE) assays.

AML requires 20% blasts in blood or marrow for diagnosis.


DIAGNOSIS
MPO NSE
DIAGNOSIS
The presence of the following inclusions is helpful in the
diagnosis of AML:

Auer rods, eosinophilic rod-like cytoplasmic inclusions


derived from myeloperoxidase-positive primary granules.

Phi bodies, strings of eosinophilic bead-like granules from


catalase-positive microperoxisomes.
DIAGNOSIS
DIAGNOSIS
DIAGNOSIS

Myelocytes
DIAGNOSIS

Myeloblasts
Thank You

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