Practical briefing for year 1 M.B.,B.S Students in Unikl,RCMP

1. LEUKEMIA

2. Leukemia
Leukaemias are diseases in which
abnormal proliferation of
haemopoietic cells causes
progressively increasing
infiltration of the bone marrow

3. Learning outcomes
 Define and Classify Leukemia
 Classify Acute Myeloid leukemia by using revised
FAB classification
 Discuss the etiology, pathogenesis , clinical
manifestation, blood and bone marrow morphology
of ALL,AML,CLL,CML.

4. LEUKEMIA
Acute Leukemia
Acute lymphoblastic leukemia (ALL)
Acute Myeloid Leukemia (AML)
Chronic Leukemia
Chronic lymphocytic leukemia(CLL)
Chronic Myeloid leukemia (CML)

5. Blood picture of Acute Leukemia
Total WBCs count ranges between
subnormal to markedly elevated values
The majority >20% of leucocytes are
blast cells
Lymphoblasts with condensed nuclear chromatin,
small nucleoli, and scant agranular cytoplasm

6. Blood picture of Acute Leukemia
Anaemia normochromic normocytic
characteristically progressive and severe with
anisocytosis and poikilocytic, sometimes with
mild polychromasia
Thrombocytopenia is also extremely common,
often being severe, with platelet counts well below

7. BLAST
The very basic morphological features of typical
myeloblasts, lymphoblasts, and monoblasts are similar

8. The most life saving thing you can learn today is
how 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

9. Acute lymphoblastic leukemia (ALL)
Lymphoblasts with condensed nuclear chromatin, small
nucleoli, and scant agranular cytoplasm

10. Blood picture of Acute lymphoblastic
leukemia (ALL)
Total WBCs count ranges between
markedly elevated increased
The majority >20% of leucocytes are
Lymphoblasts with condensed nuclear chromatin,
small nucleoli, and scant agranular cytoplasm

11. Bone marrow aspirate shows neoplastic promyelocytes
with abnormally coarse and numerous azurophilic granules.
Other characteristic findings include cell that contains
multiple needle-like Auer rods
Acute myeloid leukemia (AML) FAB M3
Auer ‘s rod

12. 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)

13. Auer ‘s rod
Auer ‘s rod
Blood picture of Acute myeloid leukemia
(AML) FAB M3

14. Blood picture of Acute Myeloid leukemia
(AML) FAB M3
Total WBCs count ranges between
markedly elevated increased
The majority >20% of leucocytes are
promyelocytes with abnormally coarse and
numerous azurophilic granules and prominent
nucleoli. Some promyeloblasts contain multiple
needle-like Auer rods

15. Lab features
Other lab features :
NAP(neutrophil alkaline phophtase activity
score) reduced
Serum B12 and transcobalamin increased
Serum uric acid increased
Lactate dehydrogenase increased
Cytogenetic : Philadelphia chromosome
t(9,22)

16. Chronic Myeloid leukemia (CML)
Peripheral blood smear shows marked leucocytosis with the
presence of whole spectrum of myeloid cells including many
mature neutrophils, some metamyelocytes, and a myelocyte
and basophilia

17. Peripheral blood film
Anaemia
Leukocytosis (usu >25 x 109/L, freq> 100 x
109/L
WBC differential shows granulocytes in all
stages of maturation
Basophilia
thrombocytosis
Chronic Myeloid leukemia (CML)

18. Chronic Lymphocytic leukemia (CLL)
SMUDGE CELLS
large numbers of small round lymphocytes with scant
cytoplasm and smudge cells (disrupted cells )and
spherocytes
Nucleated RBC
spherocytes

19. Chronic Lymphocytic Leukemia (CLL)
Blood pictures
peripheral blood smear shows increased
small lymphocytes condensed chromatin
and scant cytoplasm
A characteristic finding is the presence of
disrupted tumor cells (smudge cells) and
the presence of spherocytes
(hyperchromatic, round erythrocytes)
A nucleated erythroid cell is present

20. •peripheral lymphocytosis (>200,000)
•increased susceptibility to bacterial
infection (most frequent cause of death)
•may associated with autoimmune
hemolytic anemia
Chronic Lymphocytic Leukemia (CLL)

21. Neutrohil leucocytosis in severe
infection :
Increase in total count &presence of
of immature cells known as SHIFT
TO THE LEFT

22. more marked than usual 
LEUKEMOID BLOOD PICTURE
many immature granulocytes appear in the
blood simulating a leukemia
(leukemoid reaction)

23. Leukemoid Reaction
Marked increase in neutrophils. >50,000 x109
Shift to left  immature forms.
Severe infection, trauma, bone marrow infiltration
Looks like leukemia*
(no blasts)

24. 1. Describe the morphology of the cell (pointed with arrow) in the photomicrograph
provided. Name the cell.
A photomicrograph of a tissue section of an enlarged lymph node obtained from
51 years old man is provided