WHO Chapter 1 Flashcards
Number of cells on a peripheral blood manual differential count
200
Number of cells on a marrow aspirate manual differential count
500
Cells included in marrow aspirate differential
blasts, promonocytes, promyelocytes, myelocytes, metamyelocytes, bands, segmented neutrophils, eosinophils, basophils, monocytes, lymphocytes, plasma cells, erythroid precursors, mast cells (megas are not included)
Core biopsy should be…
1.5 cm in length, at a right angle to cortical bone, ≥10 partially preserved intertrabecular areas
Cells included in blast count
myeloblasts, monoblasts, megakaryoblasts

Myeloblast

- Myeloblast
- Promyelocyte

- Promyelocyte
- Myelocyte
- Metamyelocyte
- Polychromatic erytoblast

Myelocyte

- Myelocyte
- PMN

Metamyelocyte

PMNs with toxic granulation

- Toxic granulation, cytoplasmic vacuoles, Dohle bodies
- Monocyte

- Proerythroblast
- Myeloblast
- Promyelocyte
- Metamyelocyte
- PMN

- Polychromatic erythroblast
- Orthochromic erythroblast

- Lymphocyte
- Orthochromatic erythroblast

PMN with peroxidase reaction

PMN with alkaline leukocyte phosphatase (ALP)

Hypersegmented (>/= 6) PMN

Drumstick as an appendage with thin filament bridge to the nucleus (associated with X-chromosome)

Very large PMN following chemotherapy

PMN after prolonged (>8 hours) storage

Monocyte

Monocyte

Monocyte

Monocyte with esterase stain

Phagocytic monocyte

Neonatal lymphocyte

Lymphocyte

Osteoclast


Fibroblasts

Monoblast, promonocytes

Megakaryoblast
Monoblasts and promonocytes count in which leukemias?
Acute monoblastic leukemia
Acute monocytic leukemia
Acute myelomonocytic leukemia
Monoblasts
NSE+
MPO+/-
May have pseudopod formation
Abundant cytoplasm
Round nucleus
Prominent nucleoli
Promonocyte
NSE+
MPO+
Finely dispersed chromatin
Folded/grooved nucleus
Indistinct/absent nucleolus
Finely granulated cytoplasm
Abnormal monocyte
Clumped chromatin
Variably indented, folded nucleus
Grey cytoplasm with more liliac granules
Absent/indistinct nucleoli
Blast equivalents in:
- APL
- Pure eythroid leukemia
- Promyelocyte
- Proerythroblasts
MPO
Myeloid differentiation
Absence doesn’t exclude (early myelo/mono-blasts may lack)
Often granular/Golgi staining
Monoblasts/promonocytes show fine, scattered granules
Negative in erythroid blasts, megakaryoblats, lymphoblasts
Sudan Black
Parallels MPO staining, less specific
Occasional lymphoblastic leukemias show + (light grey granules rather than deeply black characteristis of myeloblasts)
NSE
- α-napthyl butyrate (ANB)
- α-napthyl acetate (ANA)
Diffuse cytoplasmic activity in monoblasts and monocytes
Lymphoblasts mya have focal punctate activity with NSE
Negative in PMNs
Megakaryoblasts & erythroblasts may have some mulitfocal, punctate ANA+ but it is partially resistant to NaF inhibition (monocyte NSE is totally inhibited by NaF)
CAE
naphthol-ASD-chloroacetate esterase
stains cells of neutrophil lineage and mast cells
negative in normal eos, may be + in neoplastic eos
CAE + NSE
permits ID of monos and immature/mature PMNs simultaneously
myelomonocytic leukemias particularly express both
PAS
+ in cytoplasm of leukemic proerythroblasts in erythroid leukemia (large globules)
Ring Sideroblast
>/= 5 granules encircling >/= 1/3 nucleus
15% of cells in BM for RARS