• When diagnosed for first time, it should be

called AML only and not CML

• BFU in erythroid and megs only
• Pathways-3: JAK/STAT- MAP- PI3
• E2F : G1 to S (E2F<-Rb<-P53) Control
• relies on the
– morphological,
– cytochemical,
– and immunophenotypic features
• establish
– their lineage
– and degree of maturation: (or precursor)
– Eg Burkit has mature cells in circulation
• determine whether the cellular appr is
– cytologically normal, dysplastic, otherwise morphologically
abnormal.
• Prior to therapy
• Blast percentages
– Categorizing neoplasms
– Monitoring progression
• Cytogenetic & mol studies
– Diagnostic
– Baseline
 Peripheral Blood
• PBS vs CBC
• MGG/WG
• Freshly prepared and well controlled
• Ref Neutrophil granules esp Myeloid context
• -> dysplasia (hypogranular-> false label)
• DLC- Manual 200 cell
• RBC- tear drop etc
• Platelet- size & gran
 BMA
• MGG/WG
• Cell Morph- Nuclear chromatin & Cytoplasm gran
• DLC- 500 nucelated cell count for calc blast%
• Site-
– as close to particle as possible
– as undiluted blood as possible
• Irreg cell distb-Multiple smears may be used for counts
• Cell index-
– Blasts//Promyelo/Myelo/Metamyelo/Band/Segmented
Eos/Baso/Mono/Lympho/PC// Erythroid prec //Mast c
• Megs NOT included in differential
• Concomitant non myeloid mx- exclude from counts
• Dry taps-fibrosis/cell packed- use touch impressions
• Imprint smears- don’t damage biopsy
• Compare counts with biopsy sections when they come
 BM Biopsy
• Age match cellularity
• Histotopography
• HSC- proportion & maturation
• BM Stroma
• Cancellous bone structure
• IHC-diag & prognosis
• Adequacy
– Right angle from cortical bone
– 1.5cm long=10 partial;y preserved marrow spaces
• Well fixed
• Thin sections at 3-4 microns
• Stain- H&E/ Geimsa
• Fibrosis/collagen- Silver impregnantion
• Megs-PAS
• Blasts
• Dx- PBS(200)/ BMA(500)
• IHC- CD34 [SOME Myeloid Neo DONOT exp]
• FCM- hemodilute+preanalytic var-> NOT Blast
Count
• Blast fam- Myelo+Mono+Megakaryoblasts
Myeloid Monoblast Promonocyte Megakaryoblasts

WHO- WHO WHO

Size- Slightly bigger Size-Large cell Size- small to med
than Mat Lymph to
Mono
Cyto- Cyto-
scant to abundant Cyto- Cyto-finely Basophilic
Dark blue to blue Abundant granulated Agranular
gray Blebs
Azurophilic gran Light gray to deep
Nuclei- blue
Rd to oval Pseudopod formn+ Nucleus-
Chr-Finely gran Nuclei- Nucleus- Rd/indent/irreg
Nucleoli- multiple Round Delicately Ch-fine reticular
Chr- delicate/lacy convoluted,folded or Nuccleili-1-3
Nucleoli-One/more grooved with
prominent Chr-Finely dispersed
Nucleoli-
small/indistict/absen
t
Stains-NSE>>>MPO Stains-NSE+MPO
(wk)
Vs mature abnormal

Nucl- var indented

folded
Chr- MORE clumped
Nucleoli-
absent/indisticnt
Cyto- abundant lilac
gr