HEMATOLOGY 311 nels

FINALS WEEK 13 & 14: NEOPLASTIC AND RELATED

DISORDERS AND BLOOD CELL CYTOCHEMISTRY
✓ In between acute and chronic leukemia.
MALIGNANT LEUKOCYTE DISORDERS
✓ Lasting from 2 to 6 months or even 12 months.
NEOPLASTIC/TUMOR AND RELATED DISORDERS
1. Leukemias and Leukemoid Reactions
2. Myeloproliferative Disorders
3. Lymphoproliferative Disorders
4. Plasma Cell Dyscrasias and Lymphoreticular
Malignancies Associated with Abnormal
Immunoglobulin Synthesis

LEUKEMIAS
✓ Are generalized neoplastic proliferations or
accumulation of leukopoietic cells with or without
involvement of the peripheral blood.
-In other words, the bone marrow makes abnormally
large number of immature blood cells.
✓ Cancer of WBC
*read
CLASSIFICATION OF LEUKEMIA Neutropenia: decrease neutrophils
1. Chronologic (based on natural history) Organomegaly: organ enlargement
2. Cytologic (based on predominant cell type) WBC count in acute will be low, normal or high but in chronic
-What is the predominant or most numerous cells. all are elevated WBC count.
3. Classification based on functional capacity of ANLL: acute non-lymphoblastic leukemia
release mechanism ALL: acute lymphoblastic leukemia
4. Classification based on localized proliferation of CML: chronic myeloid (myelogenous) leukemia
cells of the same type CLL: chronic lymphoblastic leukemia

I. CHRONOLOGIC (BASED ON NATURAL HISTORY) II. CYTOLOGIC (BASED ON PREDOMINANT CELL TYPE)
-Can be from myeloid (m) or common lymphoid (l) 1. GRANULOCYTIC OR MYELOCYTIC LEUKEMIA
progenitor. a. Acute Myeloid/ Myeloblastic Leukemia
-Can be ALL or AML or CLL or CML. Myeloid: all cells came from common myeloid
1. ACUTE LEUKEMIA (AL) progenitors.
✓ The most common form of leukemia in children. b. Chronic Myeloid Leukemia
-Acute lymphoblastic anemia (ALL) that is common in c. Promyelocytic Leukemia – atypical promyelocyte
children. -All predominant cells are promyelocyte.
✓ Characterized by a rapid increase in the numbers if d. Myelomonocytic Leukemia - Myeloblast
immature blood cells. e. Eosinophilic Leukemia – all precursors for eosinophil
✓ Rapidly progressing, lasting for several days to six
months. 2. LYMPHOCYTIC / LYMPHOID LEUKEMIA
-Shortens life span. -Predominant cells are common lymphoid progenitors
✓ IMMATURE, Abnormal such as: b cells, t cells
-Immature is bigger and has a darker color because of a. Acute Lymphocytic Leukemia
the presence of RNA. b. Chronic Lymphocytic Leukemia

2. CHRONIC LEUKEMIA (CL) 3. MONOCYTIC LEUKEMIA – monocytes and precursors

✓ Characterized by the excessive build-up of relatively 4. PLASMA CELL LEUKEMIA
mature, but still abnormal, white blood cells. 5. MAST CELL LEUKEMIA
✓ Mostly occurs in older people, but can theoretically 6. HISTIOCYTIC LEUKEMIA
occur in any age group. 7. MEGAKARYOCYTIC LEUKEMIA
✓ Most patients will live a minimum of 1 or 2 years or 8. BASOPHILIC LEUKEMIA
more.
✓ MATURE, Abnormal III. CLASSIFICATION BASED ON FUNCTIONAL CAPACITY OF
RELEASE MECHANISM
3. SUB-ACUTE LEUKEMIA 1. Leukemic Leukemia
Reference: Mrs. Agnes Guzman, RMT
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DISORDERS AND BLOOD CELL CYTOCHEMISTRY
✓ Presence of immature or abnormal cells with WBC
counts greater 15 x 109/ L.
2. Sub-leukemic Leukemia
✓ With immature or abnormal cells in peripheral blood
and with WBC count less than 15 x 109/L.
3. Aleukemic Leukemia
✓ With no immature cells in the peripheral blood and
9
with WBC count less than 15 x 10 /L or sometimes
normal.
IV. CLASSIFICATION BASED ON LOCALIZED PROLIFERATION
OF CELLS OF THE SAME TYPE
1. CHLOROMA
✓ A type of myeloblastic leukemia.
-From granulocytic precursor cells
-Known as granulocytic sarcoma
-Cells involved are myeloblast, promyelocytes and
myelocytes.
✓ Formation of tumors originating from periosteum,
especially of skulls, orbits, nasal sinuses, ribs and
vertebrae. (found outside the BM)
-Could also be nasopharyngeal or in the eye.
✓ Malignant green colored tumor arising from myeloid
tissue or made up of granulocyte precursor cells
✓ CNS  affinity / Granulocytic sarcoma
2. MYELOBLASTOMA
✓ A focal malignant tumor composed of myeloblast or
early myeloid precursors occurring outside of the
bone marrow.
-From granulocyte precursor cells
✓ Myeloblast/ brain or spinal cord
3. MYELOMA
✓ Local tumorous proliferation of plasma cells in the
marrow.
✓ Cancer of plasma cell accumulates in the bone
marrow.
✓ E.g. Multiple myeloma (cancerous plasma cells)
4. Lymphoma
✓ Proliferation of one of the cells types of the
lymphopoietic reticular tissue.
-Lymphatic system is involved.
✓ It begins and involves lymph nodes predominantly
and sometimes other sites such as spleen and GIT.
✓ Lesions of lymphatic system
Reference: Mrs. Agnes Guzman, RMT
✓ E.g. Hodgkin’s disease and Non- Hodgkin’s disease
LEUKOMOID REACTIONS
✓ Is a reactive but excessive leukocytosis characterized by
the presence of immature cells in the peripheral blood.
✓ Increase WBC count because of infection or other
disease
-Increase are due to infection or disease. It will be
normal if the underlying conditions are resolved.
✓ We have a test that differentiates leukomoid reactions
from CML using a LAP (stain) score.
✓ Mimics leukemia due to increase WBC count
-LAP score test: stain that differentiate if the patient
has a leukomoid reaction or CML
Causes:
1. Severe infections
2. Hemolytic anemias
3. Tuberculosis
4. Trichinella spiralis infestation
MYELOPROLIFERATIVE DISORDERS
✓ Group of neoplasm characterized by proliferation of
myeloid tissue and elevation in one or more myeloid
cell type in the peripheral blood.
-Ex: Polycythemia vera
✓ Group of disease of BM
✓ Panmyelosis → increased BM cells
✓ Pathologic condition
2 TYPES OF MYELOPROLIFERATIVE DISORDERS
1. ACUTE MYELOPROLIFERATIVE DISORDERS
a. Myeloblastic Leukemia - megaloblast
b. Promyelocytic Leukemia – promyelocyte
c. Myelomonocytic Leukemia – granulocyte and
monocyte
d. Di Guglielmo’s Syndrome
-Also known as Myeloid Erythroleukemia
-Myeloid, M6
-Prolong bleeding, polycythemia, splenomegaly, 
platelet
2. CHRONIC MYELOPROLIFERATIVE DISORDERS
a. Polycythemia Vera
b. Myelofibrosis with Myeloid Metaplasia: bone
marrow become spongy and will result in fibrosis
of bone marrow (hallmark)
c. Thrombocythemia
d. Chronic Myelogenous Leukemia
e. Myelodysplastic Syndromes
a) Polycythemia Vera (Primary Polycythemia)
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DISORDERS AND BLOOD CELL CYTOCHEMISTRY
-Is a neoplastic clonal MPD that commonly manifests
with panmyelosis in the bone marrow and increases in
RBC, granulocytes, and platelets in the peripheral blood.
-A rare disease that occurs more often in men than
women.
-Hemoglobin will go as 25g/dL or higher
-Hematocrit will go as high as 60% or 0.60
-Shows vertigo, headache, blurred vision, ringing in the
ears, itching eyes.
✓ HALLMARK: Panmyelosis
✓ Lab Findings:  TIBC, plt,  serum B12,
 Hb (18 – 24 y/o), RBC = 10 – 12 x 1012/L
✓ Treatment:
o Therapeutic phlebotomy around 500mL of blood
o Warfarin, comadin, heparin
b) Myelofibrosis
✓ Other names:
o Myeloid Metaplasia
o Chronic Idiopathic Myelofibrosis
o Osteomyelofibrosis
✓ Classified as a MPD in which the proliferation of an
abnormal type of BM stem cell results in fibrosis
(kumakapal, may butas butas, and scarring), or the
replacement of the marrow with collagenous
connective tissue fibers.
✓ Since the bone marrow is not acting well, it produces
more WBC than normal.
✓ HALLMARK: Progressive Panmyelofibrosis, Fibrosis of
BM
c) Thrombocythemia
✓ Primary Hemorrhagic Thrombocythemia
✓ Characterized by autonomous proliferation of the
megakaryocytic cell lines
✓ Thrombocytosis is present without reactive cause
✓ Signs and Symptoms: Vomiting blood, GI bleeding,
Headache, Epistaxis (nose bleeding),
✓ Lab findings:
Platelet 1000 x 109/L WBC count (nasa 450 lang tayo)
d) Chronic Myelogenous Leukemia (CML)
✓ Is a MPD arising as a clonal process from a
pluripotential stem cell
✓ Begins with a chronic clinical phase that progresses to
an accelerated phase in 3 to 4 years and often
terminates as an acute leukemia.
✓ A characteristic feature present in proliferating
hematopoietic cells is the Philadelphia Chromosomes
(Chrom. 22)
-CML and leukomoid reactions uses LAP scoring to
differentiate.
-LAP scoring is used to determine if the patient has CML
✓ Problem: Common myeloid
✓ Bleeding, Splenomegaly, Anorexia, Anemia
Reference: Mrs. Agnes Guzman, RMT
✓ 300 x 109/L WBC count
e) Myelodysplastic Syndromes
✓ Group of clonal disorder of neoplastic pluripotential
stem cells
✓ Characterized by decreased in one or more types of
peripheral blood cells due to abnormal maturation in
the BM.
-There will be non-functional cells or any type of
production of cells
FAB Classification of Myelodysplastic Syndrome
• Refractory Anemia: any treatment has no effect or
response.
• Refractory Anemia with Ringed sideroblasts: have
excess iron in periphery of RBC.
• Refractory anemia with excess blasts (RAEB)
• Chronic myelomonocytic leukemia (CMML)
• Refractory anemia with excess blast in
transformation (RAEB-t)
*read
Dyserythropoiesis: non-functional production of RBC
Dysgranulopoiesis: non-functional production of granulocytes
Dysmegakaryopoiesis: non-functional production of
megakaryocytes
LYMPHOPROLIFERATIVE DISORDERS
✓ Represent a group of neoplastic conditions originating
from cells of the lymphoreticular system.
✓ Benign and malignant lesion
TYPE OF LYMPHOPROLIFERATIVE DISORDERS
1. Acute Lymphoid Leukemia: BM and PB
2. Chronic Lymphoid Leukemia: cells that came from
common lymphoid progenitors.
3. Hairy Cell Leukemia: use of TRAP (tartrate resistant
acid phosphatase) stain.
4. Mycosis Fungoides and Sezary’s Syndrome:
cutaneous t-cell lymphoma that affects the skin.
5. Malignant Lymphoma
a. Hodgkin’s Disease
b. Non-Hodgkin’s Disease
c. Burkitt lymphoma
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FINALS WEEK 13 & 14: NEOPLASTIC AND RELATED
DISORDERS AND BLOOD CELL CYTOCHEMISTRY
- Nodular lymphocyte – predominant Hodgkin
HAIRY CELL LEUKEMIA lymphoma
✓ Leukemia Reticuloendotheliosis - Is a B-cell neoplasm composed of relatively rare
✓ Composed of small B-lymphocytes with abundant neoplastic cells scattered within the nodules of
cytoplasm and fine (hairy) cytoplasmic projections in reactive lymphocytes.
the periphery. - Burkitt’s Lymphoma
✓ Diagnosis by TRAP - stain
✓ Insidious onset weakness, splenomegaly Plasma Cell Dyscrasias and Lymphoreticular
✓ Very rare condition Malignancies Associated with Abnormal
Immunoglobulin Synthesis
MYCOSIS FUNGOIDES 1. MULTIPLE MYELOMA
✓ Also known as Alibert-Bazin Syndrome. - Other Names:
✓ The most common form of cutaneous T-cell lymphoma. o Plasmatocytoma
✓ Is a lymphoreticular neoplasm primarily involving the o Kohler’s Disease
skin. - Is a neoplasmic proliferation of morphologically
-There is an infiltration in the lymph nodes and other abnormal plasma cells primarily occurring in the BM
visceral organs. either in nodules or diffusely.
✓ As the disorder evolves, neoplastic cells infiltrate the - Association of osteolytic bone lesion and monoclonal
lymph nodes and other visceral organs. immunoglobulin in either serum or urine.
✓ MAJOR STAGES: - Slowly multiplies.
1. Initial Erythematous Stage – red scaly - Plasma cell cancer
weeping skin resembles eczema psoriasis - Lab Findings:
2. Plaque Stage o Plasma cell in BM
3. Final Tumor Stage o (+ or high) Bence Jones Protein in serum and
✓ Lab Findings (HALLMARK): Large lymphocytes with urine
cerebriform or hyperconvulated cell (sezary cell) o  ESR / Roleaux formation (stacked coins
formation because of high plasma content)
MALIGNANT LYMPHOMAS: - BM examination, Urine protein, Serum
a. HODGKIN’S DISEASE electrophoresis
- Classical Hodgkin Lymphoma
- 95% B-cell and 5% T-cell 2. WALDENSTROM’S MACROGLOBINEMIA
- A malignant disorder characterized by painless, - Indolent Lymphoma
progressive enlargement of lymphoid tissue - Is an uncommon condition which behaves as a slowly
- HALLMARK is the large binucleated or progressive lymphoma.
multinucleated cell with each nucleus bearing a - Is proliferation of cells which produce a monoclonal
very large nucleolus (Reed-Sternberg Cell: IgM paraprotein.
confirmatory for hodgkin’s) *The paraprotein coats the cells that’s why this
condition has low platelet count because it targets the
platelets itself.
- Lab Diagnosis:
o Asymptomatic with decrease IgM level (3 g/dl)
o Organomegaly
o Hyperviscosity (due to
hypergammaglobulinemia) syndrome
o Cancer/Malignant Cell o Anemia
o Popcorn Cell
o Binucleated with 2 prominent OTHER LEUKOCYTE DISORDERS:
eosinophilic nucleoli resembling OWL’s 1. INFECTIOUS MONONUCLEOSIS
EYES - Other names:
- Mostly B-lymphocytes o Glandular Fever
- Discovered by Thomas Hodgkin o Pfeiffer’s Disease
o Kissing Disease
b. NON-HODGKIN’S DISEASE - Characterized by fever, sore throat,
lymphadenopathy and presence of atypical

Reference: Mrs. Agnes Guzman, RMT

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FINALS WEEK 13 & 14: NEOPLASTIC AND RELATED
DISORDERS AND BLOOD CELL CYTOCHEMISTRY
lymphocytes (also known as virocytes/downy
cells/turk’s irritation) in the blood.
- T-cells reacting against B-lymphocytes infected with
Epstein-Barr (EB) Virus.
*Enlargement of lymph nodes
- Associated with high titer of heterophile Ab reacting
with sheep red cells.
2. HISTIOCYTOSES/STORAGE DISEASE
- Represent a group of diseases with abnormal
proliferation of mesenchymal cells that are closely
related to phagocytic histiocytes and to fat cells.
*Gaucher disease and Niemman-pick disease are
example of storage disease. It is characterized by joint
stiffness, pain, seizures, delay in intellectual and
physical development, anemia, nose bleed, swollen
abdomen due to enlarged spleen and liver.
- Due to inborn errors in metabolism genetically
transmitted.
3. SYSTEMIC LUPUS ERYTHEMATOSUS
- Is a collagen disease which affects women most
commonly.
*Characterized by butterfly/malar rash.
*Is photosensitive
*No known treatment except supportive treatment
and corticosteroids (people taking corticosteroids has
moon face apppearance)
*Autoimmune disorder.
*Immune system attacks the healthy cells.
- Characterized by skin rash, arthralgia, fever, renal,
cardiac and vascular lesions, anemia, leukopenia, and
thrombocytopenia
3 Types of Antibody (Antinuclear Ab/ANA)
a) Anti-DNP
b) Anti-DNA
c) Anti-nuclear
4. AIDS – ACQUIRED IMMUNODEFICIENCY SYNDROME
- A disorder secondary to an infection with the human
immunodeficiency virus (HIV).
- HIV – a RNA retrovirus that is cytotropic for CD4
positive T cells and macrophages.
- Treatment: No known treatment except anti-viral
meds.
BLOOD CELL CYTOCHEMISTRY p.613, 5th Ed., Rodaks
-Techniques such as flow cytometry, cytogenetic analysis and
molecular testing are now commonly used in the diagnosis of
leukemia. Blood cytochemistry is the older technique and is
still being used in the laboratory.
Reference: Mrs. Agnes Guzman, RMT
USES OF CYTOCHEMICAL STAINS
1. Used in the study of cell differentiation and in the
classification of acute leukemias
2. Used in the differentiation of leukocytosis and
leukemoid reactions from genuine myeloproliferative
disorders
-Through the use of LAP stain
3. Used in the characterization of lymphoproliferative
disorders
4. Used in the demonstration of free ion, Hb derivatives,
DNA, RNA, and red cell enzymes in RBC and WBC
CLASSIFICATION OF CYTOCHEMICAL STAINS
1. PEROXIDASE STAIN/MEYELOPEROXIDASE
➢ Differentiates AML from ALL
-Remember that MPO is present in the granules
of most granulocytic cells.
➢ Methods: (1) Hattori, (2) Kaplow, (3) Hanker
Principle:
In the presence of hydrogen peroxide, MPO in
granulocytes oxidizes benzidinedihydrochloride from a
colorless to a reddish-brown derivative at the site of the
enzyme.
• Positive: Acute Myeloid Leukemia (AML)
• Negative: Acute Lymphoid Leukemia (ALL)
2. SUDAN BLACK B STAIN
-SBB stains phospholipids and lipoproteins. It is also used
to differentiate AML and ALL.
Principle:
It stains lipids, such as sterols, neutral fats, and
phospholipids because of the solubility of the dye in lipid
particles and appears dense black (+).
• Positive: Acute Myeloid Leukemia (AML)
 POSITIVE SUDANOPHILIC
• Negative: Acute Lymphoid Leukemia (ALL)
 SUDANOPHOBIC (monocyte is not
strong in color)
 Monocyte: less stain
 Lymphocytic cells: negative or no stain
 Granulocytic cells stain and auer rods:
bluish black
3. STAIN FOR ESTERASES
➢ Differentiate granulocytic from monocytic
leukemias.
a. Naphthol AS-D Chloroacetate Esterase (Specific
esterase test)
b. -Detects esterase enzyme which is present in the
granulocytic cells.
• Positive: Granulocytic Leukemia (RED)
• Negative: Monocytic Leukemia
c. α-naphthyl Acetate Esterase (Non-specific esterase
test)
 HEMATOLOGY 311 nels
FINALS WEEK 13 & 14: NEOPLASTIC AND RELATED
DISORDERS AND BLOOD CELL CYTOCHEMISTRY
-Detects esterase enzyme which is present in the 6. LEUKOCYTE ALKALINE PHOSPHATASE (LAP) STAIN
monocytic cells. - Differentiates CML from a leukemoid reaction seen in
• Positive: Monocytic Leukemia (BLUISH severe infections.
BLACK) - Whole Blood (EDTA)
• Negative: Granulocytic Leukemia - Check for the NEUTROPHIL → present in cases with
severe infection
4. PERIODIC ACID SCHIFF (PAS) REACTION (RED) - Stains the primary and secondary granules
➢ Gives a positive reaction to polysaccharides, - Methods:
mucopolysaccharides, glycoproteins and glycogen o Baliff and Kimbrough
➢ Useful in diagnosis of Erythroleukemia and ALL. o Sheenan and Staney
Principle:
Periodic acid is an oxidizing agent that converts LAP SCORING: is used to differentiate chronic myelogenous
hydroxyl groups on adjacent carbon atoms to aldehydes leukemia from a leukomoid reaction.
and further combined with Shiff’s reagent to give red Findings Score
color/bright red product. Normal 20-100
 Positive: CML <13
o Granulocytes Leukemoid Reaction >100
o Platelets Polycythemia Vera 100-200
o Erythroleukemia (Is M6 Based on FAB Secondary Polycythemia 20-100
classification)
 Negative:
o Acute Lymphoid Leukemia (ALL)
o Burkitt Lymphoma (NHL)

5. FACTOR VIII ANTIBODIES

Principle:
Monoclonal or polyclonal antibodies against factor
VIII-related antigen have given positive results in
megakaryoblastic leukemia.
NASDA

Factor
ANAE

-After performing the smear, you need to read 100

MPO

SBB

PAS

VIII

Condition
neutrophils. For example, you saw no staining, that would be
graded as zero.
1. ALL – – – –/+ V – -Ex:
*Zero = No staining with reading of 40
2. AML + + + – V – *25 cells that are faint and diffused
-After counting 100 cells, you need to multiply the reading to
3. AMMoL + + + + V – the grading (ex: 0x40=0), add it up, then interpret whether it
is a CML or leukomoid reaction.
4. AMoL + ± – + V – *Leukomoid reaction mimics the anemia due to its high WBC
count because of severe infection.
5. EL + + + – + –

6. ML – – – – – +

Notes:
AMMoL: Acute myeloid monocytic leukemia
AMol: Acute monocytic leukemia
NASDA: Naphthol AS-D Chloroacetate Esterase
ANAE: α-naphthyl Acetate Esterase
 + Myeloblast
 – Normoblast

Reference: Mrs. Agnes Guzman, RMT

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FINALS WEEK 13 & 14: NEOPLASTIC AND RELATED
DISORDERS AND BLOOD CELL CYTOCHEMISTRY
FAB CLASSIFICATION OF ACUTE LEUKEMIA
Characterisctic Leukemoid Reaction CML French American British Classification of Anemia
LAP   - A schema that divides acute leukemias into lymphoid
Toxic (ALL) or myeloid (AML) cell lines.
 
Granulation *Acute lymphocytic leukemia
Dohle Bodies Yes No (L1): most common childhood leukemia and is also
Philadelphia found in young adults. Small lymphoblasts and has
No Yes homogenous appearance and is the best prognosis.
Chromosomes
(L2): small and large lymphoblasts with heterogenous
7. ACID PHOSPHATASE (TARTRATE RESISTANT) appearance that is most common in adults
- Diagnostic tool for confirmation of hairy cell leukemia. (L3): large homogenous lymphoblasts and the leukemic
phase of Burkitt lymphoma.
8. PRUSSIAN BLUE/PERL’S STAIN - Percent (%) or presence of Blast
- Stain for iron
- It gives a positive reaction in cases of cells containing
iron, ringed sideroblasts, and siderocytes.

9. TOLUIDINE BLUE
- Differentiates basophilic leukemia and mast cell
- leukemia from other diseases.
- Positive result is metachromatic granules which are
colored reddish violet and is observed in mast cells
and basophilic leukemia.
FAB CLASSIFICATION OF ALL
Stain/ Cell Marker Tests For: Indication L1 L2 L3
1. Peroxidase Myeloperoxid AML Small cells Large Large
ase AMMoL (weak +) Cell Size
Predominate heterozygous homogenous
2. Sudan Black B Lipid AML Regular with Irregular and
AMMoL (weak +) Nuclear Regular oval
occasional indentation
3. Specific Esterase Granulocytic AML Shape to round
indentation common
precursors AMMoL Not visible/ 1 or more Prominent
Nucleoli
4. Non-specific Monocyte AML small large 1 or more
Esterase precursors AMoL Variable of Moderately
Cytoplasm Scanty
5. PAS Glycogen Erythroleukemia, ten abundant abundant
ALL negative Burkitt/
6. Tartrate-Resistant Tartrate- Hairy Cell Rarest
Acid Phosphatase resistant acid Leukemia Age Childhood Adult (Children
(TRAP) phosphatase and Young
7. NBT (Nitro blue Granulocyte CGD adult)
tetrazolium) function Best Poor
8. TdT (Terminal Early T and B ALL prognosis prognosis
deoxynucleotidyl lymphocytes
transferase)
9. LAP Alkaline  Leukemoid
phosphatase Reaction, PV,
 CML
10. Prussian Blue Iron Sideroblastic
Anemia
11. Phyloxine Acid granules Eosinophilia

Reference: Mrs. Agnes Guzman, RMT

 HEMATOLOGY 311 nels
FINALS WEEK 13 & 14: NEOPLASTIC AND RELATED
DISORDERS AND BLOOD CELL CYTOCHEMISTRY

*Acute Myeloid Leukemia

1. M1 Myeloblasts without maturation. This shows
90% or more marrow myeloblast and presence
of auer rods.

2. M2 Myeloblasts with maturation (Best AML

prognosis). This shows less than 90% marrow
myeloblasts.

3. M3 Hypergranular Promyelocytic Leukemia

4. M3V Variant, Microgranular Promyelocytic Leukemia

5. M4 Myeloblast and Monoblast.

Characterized by more or less 20% based on
WHO. In FAB, that would be greater than 20%
marrow. Proliferation of unipotential stem cell
and accounts for 30% AML.

6. M5 Monoblast.
Characterized by more or less or equal to 20%
based on WHO. If FAB, that would be greater
than 30% marrow monoblast. Accounts for 10%
AML, Non-specific esterase positive and
contains 2 variants knowns as M5A which is
seen in children and accounts to 85% monoblast
and the M5B which is seen in middle age adults
with less than 85% monoblast.
a. Poorly differentiated monocytic leukemia
b. Well differentiated monocytic leukemia

7. M6 Erythroleukemia/ Di Guglielmo Syndrome

Characterized by greater than or equal to 20%
based on WHO.

8. M7 Megakaryocytic Leukemia.
Characterized by proliferation of
megakaryoblasts and atypical megakaryocytes.
Accounts for <1% of AML. Marrow aspiration
results to dry tap and blood shows
pancytopenia. Difficult to diagnose with
cytochemical stains.
- Pleomorphic undifferentiated cells with cytoplasmic
blebs
- Myelofibrosis or  BM reticulin
- Positive for platelet peroxidase antifactor VIII

Reference: Mrs. Agnes Guzman, RMT