THIS PRESENTATION INCLUDE INFORMATION ABOUT THE BLOOD CELLS MALIGNANCIES, DEFINITION, TYPES AND HOW EVALUATED, FOR MEDICAL LABORATORY STUDENTS -MLS

1. Developed by
Dr.Abdulrazzaq Othman Alagbare-MD-MCP-
Hematology Lecturer
INTRODUCTION
hematological- malignant Disorders
FOR Clinical LABORATORY STUDENTS

2. The Malignant Hematological Disorders
Means malignancy for all blood cells that produce from the bone marrow
1-Leukemia for the following
cells
a) Neutrophil
b) Eosinophil
c) Basophil
d) Monocyte
e) T-Lymphocyte
f) B-Lymphocyt
2-RBC:
Polycythemia Vera (PV)
3-Thrombocytes : Essential
Thrombocythemia (ET)
4-Plasm cells
Multiple myeloma (MM)

3. Introduction-Leukemia
Definition: Leukemia is a cancer of blood white cells
Caused by the mutation of
pluripotent or most
primitive stem cells. (PSC,
MSC, LSC)
Blast cells accumulate in the Bone
marrow and
1. peripheral blood
2. Spleen
3. Lymph nodes
4. Liver
The leukemic cells are
1. Trapped early from the B.M
2. Proliferate without control (No effect of growth factors)
3. Not able to carry out their function
4. fetal disease if not treated
1

4. 1- Myeloid group malignancies
Granullar cells ––> (N. E. and B ) Leukemias
Monocytes ––> Monocytic leukemia
Erythrocytes ––> Polycythemia vera
Platelets ––> Essential thrombocythemia
2- Lymphoid group malignancies
B-lymphocytes ––> Leukemias
T-lymphocytes ––> Leukemias
Plasma cells ––> Multiple myeloma

5. Causes of leukemia or Predisposing factors
1. Inherited factors
2. Environmental
factors
3. Infection
genetic diseases e.g.
Down's syndrome,
Klinefelter's syndrome,
Fanconi's anemia,
Chemicals e.g.
Benzene
Drugs e.g.
Alkylating agents
Radiation
Viruses e.g. Epstein-Barr virus EBV, HIV,
Human herpes virus 8 (HHV-8)
Bacteria e.g. Helicobacter Pylori
Protozoa e.g. Malaria

6. FAB classification
The FAB classification is based largely on.
1-Morphology of cells
2-Simple cytochemical stains
1. At least 30% of cells in the
bone marrow or blood must be
myeloblasts.
2. and does not include cytogenetic
abnormalities
But must be

7. Differences between acute and chronic leukemia
1- Cells maturation degree (blast or mature )
2-Blood cells count in the peripheral blood
3-Patient`s symptoms
4-Clinical onset
5-organomegaly
6-patient`s age
All Leukemia divided into Acute and chronic

8. Properties of acute leukemia Properties of chronic leukemia
 Immature cells (90% blast cells )  More mature cells (60%-70% mature cells)
 Occurs in all ages  Usually occurs in adults and elderly
 Clinical onset is sudden  Clinical onset is gradual
 Anemia and thrombocytopenia are severe  Anemia and thrombocytopenia are mild
 WBC is variable (high, normal or low with 90 %
blast cells)
 WBC is increased , abnormal cells, (30% blast )
 organomegaly is mild  Organomegaly is prominent

9. Clinical Picture of acute
leukemias
Clinical Picture of chronic
leukemias
The patient has
1. Anemia
2. Bleeding
3. Infection
The patient has
1. No anemia
2. No bleeding
3. No Infection
Acute leukemia cause morbidity and mortality through :-
1. Deficiency in blood cell number and function
2. Invasion of vital organs
3. Systemic disturbances by metabolic imbalance

10. Pathophysiology
Acute leukemia cause morbidity and mortality through :-
1. Deficiency in blood cell number and function
2. Invasion of vital organs
3. Systemic disturbances by metabolic imbalance

11. Investigations need to diagnose leukemia
1. Complete blood count.(CBC or FBC)
2. Peripheral blood film inspection
3. A bone marrow examination
4. Flow cytometry or immunophenotyping studies
5. Chromosomal analysis
6. Cytochemical stains

12. 1-Complete blood count show
1. The RBC changes
2. WBC: count,
3. Platelets: count and morphology
PBS: show
1. Changes of white blood cells,
2. % of blast cells
3. Type of blast cells (myeloblast or lymphoblast etc)
4. morphologic feature (auer rods, vacuoles , the size of the
nucleus etc)

13. 2-A bone marrow examination
• mostly has hypercellular B.M and few cases hypocellular
• 20% to 90% leukemic blasts at diagnosis or during relapse.
• The blast must present in the peripheral blood, unless the WBC count is markedly
decreased.
Acute leukemia
Bone Marrow Tryphine Biopsy
It is a histological test for bone marrow tissue to obtain the blood cells
Indication: If the peripheral blood indicate
1-hypocelluar
2-aplastic anemia
3-metastic cancer
Or the previous result indicate  Dry tap bone marrow aspiration

14. 3-Flow cytometry or immunophenotypic studies
Monoclonal antibodies toward cell-type restricted antigens are used in this
highly specific method
CD markers Show for
1. blast cells
2. mature cells
and determine if it is
1. myeloid Cells types and count
2. lymphoid cells types and count
3. Normal or abnormal

15. 4- Chromosomal analysis
Chromosomal abnormalities studies is very important (diagnostic
and prognostic ) for
• AML
• ALL
critical in the diagnosis and treatment of AML.As in
ALL
Note
1-AML: Acute myeloblastic Leukemia
2-ALL: Acute Lymphoblastic Leukemia

16. 5-Cytochemical stains
Importance: very helpful in the diagnosis and classification of acute
leukemias
Specimens: bone marrow smears but may also be done on peripheral
smears
1. myeloperoxidase (MPO)
2. Sudan black B stain (SBB)
3. specific esterase stain (SE)
4. a non specific esterase stain (NSE)
5. Terminal deoxynucleotidyl transferase (TdT)
Types

17. Cytochemical Reaction Cellular Element Stained Blasts Identified
Myeloperoxidase
(MPO)
Neutrophil primary granules Myeloblasts strong positive;
Sudan Black B (SBB) Phospholipids Myeloblasts strong positive;
Specific esterase Cellular enzyme Myeloblasts strong positive;
Nonspecific esterase
(NSE)
Cellular enzyme Monoblasts strong positive
Terminal
deoxynucleotidyl
transferase (TdT)
Intranuclear enzyme Lymphoblasts positive

18. -Positive-Myeloperoxidase- (MPO)
Brown black deposits

19. Positive-Chloracetate (Specific) Esterase-Myeloid
Cell Line
Red deposit Brown deposits
Positive-Non-Specific Esterase
Monocytic Line

20. Leukocyte Alkaline Phosphatase (LAP, Neutrophil Alkaline
Phosphatase, NAP)
Definition: The LAP score is a test done by performing a chemical reaction
on a blood smear
Evaluation:
1. The blood smear is viewed under a microscope, and the degree of granular staining
in mature neutrophils (bands and segs) is graded from 0 (no staining) to 4+ (dense
granular staining).
2. The LAP score is the sum of staining for 100 cells.
3. The normal range is 20 to 100.
Principle: The granular of bands and segs with the alkaline phosphatase
enzyme colored staining.

21. LAP Score
• Count 100 consecutive segs and
bands
• Score:
0 = no granules
1+ = occasional diffuse granules
2+ = moderate number of granules
3+ = many strongly positive granules
4+ = confluent strongly positive
granules
Example:
0 x 35 cells = 0
1+ x 30 cells = 30
2+ x 20 cells = 40
3+ x 10 cells = 30
4+ x 5 cells = 20
120
LAP Score

22. 0 1+
2+ 3+ 4+

23. The two main conditions with
a low LAP score are
1. CML
2. paroxysmal nocturnal hemoglobinuria (PNH).
higher scores in
1. Polycythemia vera.
2. Myelofibrosis
3. Essential thrombocytopenia
4. leukemoid reactions
LAP score and related diseases
Precuations
1. Reject specimens collected in EDTA-anticoagulated (lavender-topped) tubes because EDTA inhibits the
activity of LAP
2. Results are invalid if the client is neutropenic (that is, <1000/mm3 neutrophils).

24. Instrumentation and leukemia
Platelets
The platelets count increased due to fragments of the
leukemic blasts, which are counted as platelets
To solve this problem
1. Platelets must be counted manually
2. Examination of a blood smear gives a more accurate
assessment of the platelet count in this circumstance.

25. Instrumentation and leukemia
WBC
Must check
1-The count on the blood smear
2-the DLC, if not agree count to 200 cells ,
report the average
Be carful for
1-the clot , old . Lipemic specimen, affects the results of CBC
2-the age of the patient (infant, child, adult) must be taken into account
3- newborns, toddlers, and young children, particular reference ranges must be taken
into account
4- a normal range is given, covering 95% of the values of healthy persons
5-The presence of abnormal cells needs clinical pathologist

26. END OF THE
LESSON