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Leukemoid and lekoerythroblastic reaction
- 2. Leukemoid reaction • Secondary reversible marked increase of WBC count >50000/cumm in response to a stimulus & immature WBCs(blasts<5%) in peripheral blood resembling leukaemia • Seen in non leukemic conditions
- 3. Causes Myeloid leukemoid reaction Lymphoid leukemoid reaction Severe bacterial infection e.g – Pneumonia, endocarditis, Septicemia & cellullitis Viral infections : IMN, chicken pox, mumps, scarlet fever Severe acute hemolysis Bacterial infections : TB, syphilis Cancer metastatic to bone marrow Others : eclampsia, burns, mercury poisoning Eosinophilic leukemoid reaction Allergic states – asthma, urticaria Parasitic diseases
- 4. Myeloid leukaemoid reaction • Total WBC count increased (>50,000/cumm) • Shift to left up to myelocyte
- 5. Differential diagnosis Parameters Leukemoid reaction CML CNL Age Any age Middle age Elderly C/F As per underlying cause Splenomegaly + Hepatoslpenomegal y RBC Anaemia minimal Severe & progressive normal TLC >50,000/cumm 50,000 - morethan 1 lakh/cumm > 25,000/cumm LAP score Increased Decreased High Cytogenetics nil BCR- ABL fusion BCR- ABL (-) & CSF3R mutation(+) Extra medullary myeloid tumours Absent Present Absent
- 6. Parameter Laekemoid reaction CML CNL Peripheral smear Leukocytes of mature forms, shift to left , with toxic granules More immature forms with basophilia & eosinophilia. Marked neutrophilia with Pro myelo, meta myelo & myelocytes (<10%), Band forms & segmented forms (>80%) Bone marrow Hyper cellular Myeloid hyperplasia, orderly maturation Markedly Hypercellular with Slight incraese in blasts, Pseudo gaucher cells Hypercellular & packed bone marrow with increased neutrophils, myeloblast <5%
- 8. CML
- 9. CNL
- 10. Lymphoid leukemoid reaction • Main differential is CLL/SLL Parameters Lymphoid leukemoid reaction CLL Age Any age > 60yrs Onset Acute Insidious Peripheral smear Reactive atypical lymphocytes Small lymphocytes, Smudge cells Clinical course Self limiting Progressive
- 12. Differentiation of leukaemoid reaction from leukaemia 1. Clinical presentation 2. Presence of underlying condition 3. Morphology of blood smear 4. % of blasts in bone marrow 5. Correction of leukaemoid picture after treatment of underlying disease
- 13. Leukoerythroblastic reaction • Presence of immature neutrophil series & nucleated red cells in peripheral blood • WBC count – Normal/high • Anaemia & high RDW • Due to disturbance in bone marrow architecture • This is known as myelophthisic anaemia
- 14. Mechanism Two major mechanisms - Altered marrow- blood barrier due to marrow infiltration - Extra medullary haematopoiesis as a compensatory response to bone marrow stress
- 15. Causes • Infectious diseases – miliary TB • Cancers metastasize to bone marrow( m/c)– ca.lung, breast, prostate, GIT, thyroid & kidney • Haematological disorders - myelofibrosis, thalassemia major after splenectomy, haemolytic anaemia lymphoma & multiple myeloma • Storage disorders (rare) - Gaucher’s disease Niemann- pick disease
- 16. • RBC – Anisopoikilocytosis hypochomia TEAR DROP cells, polychromasia NRBCs Retic Count (3-10%) • WBC – Normal / Increased / Reduced Shift to left • Platelets - Normal / Reduced / Increased in myelofibrosis abnormally large • Bone marrow biopsy is necessary in all cases for definitive diagnosis
- 17. Peripheral smear
- 18. References • Robbins & Cotran pathologic basis of disease • de Gruchy’s clinical haematology • WHO tumours of haematolymphoid system