Diagnosis of Acute Myelocytic Leukemia (AML) and Acute Lymphocytic Leukemia (ALL)

Leukemia is a malignant clonal hematopoietic stem cell disorders characterized by the rapid increase in the number of blast cells in the bone marrow and rapidly progressive fatal course if untreated. Acute leukemia (AL) are primary disorders of the bone marrow, also known as blood cancer.

What is acute leukemia?

It is defined as malignant clonal hematopoietic stem cell disorders characterized by the rapid increase in the number of blast cells in the bone marrow and rapidly progressive fatal course if untreated. Acute leukemia (AL) are primary disorders of the bone marrow, also known as blood cancer.

Classification of acute leukemias

The most widely used classification of acute leukemias is French-American-British (FAB) Co-operative Group classification. The FAB rule for the classification of acute leukemias was originally proposed in 1976. On the basis of the morphology and cytochemistry, they are classified into two major types.

1. Acute myeloid leukemia (AML)
2. Acute lymphoblastic leukemia (ALL)

Each type is further subclassified. See table 883.1

In contrast to French-American-British (FAB) classification, World Health Organization (WHO) classification recognizes AML with recurrent cytogenetic abnormalities, AML with multilineage dysplasia, and therapy-related AML as distinct entities.

Patients with clonal, recurrent cytogenetic abnormalities listed in Table 883.2 are considered to have AML irrespective of the percentage of blasts in blood or bone marrow. These patients have characteristic clinical and morphological features and a favorable response to therapy.

Difference between Acute Myelocytic Leukemia (AML) and Acute Lymphocytic Leukemia (ALL)

Sign and symptoms of acute leukemia

1. Weakness and fatigue
2. Low-grade fever
3. Bone pain
4. Bruising and mild bleeding from gums
5. It appears suddenly

Diagnosis of acute leukemia

1. This disease is most common in younger age group and more frequent in the children. Mostly found before the age of 20.
2. Rapid development of anemia is most common with normocytic and normochromic red cells. You may see some nucleated red cells in the peripheral blood smear.
3. Leucocytes (WBCs) count is variable. Mostly leucocytes count is less than 100000/μl.
4. Thrombocytopenia (See also Morphology of Platelets)
   • Petechiae and purpura may be seen in the skin and mucous membranes.

Laboratory findings in acute myelocytic leukemia (AML)

1. Total leucocyte count (TLC) is variable. It is recorded that in 25% of patient's total leucocyte count is < 5000/μl, 25% of the patient has > 50000/μl and 5% to 10% has total leucocyte count between 5000 to 10000/μl.
2. Abnormal and immature WBCs are present.
3. In 50% of cases, the value of uric acid is raised.
4. In bone marrow examination, > 20% blast cells are present. Promyelocytes are numerous especially in M3 (acute promyelocytic leukemia). See table 883.1
5. Cytochemical stains, Sudan black, and peroxidase show the positive reaction.
6. Auer rods can be seen in the cytoplasm of the cells.
7. Nucleated red blood cells may be seen.
8. PT, PTT and Thrombin time are elevated.
9. Thrombocytopenia may be present and may see the platelets count between 30,000 to 100,000/μl.

Laboratory findings in acute lymphocytic leukemia (ALL)

1. Total leucocyte count is variable from low to very high.
2. Anemia and thrombocytopenia
3. Bone marrow:
   It is difficult to find normal RBCs and WBCs.
   Very few WBCs are seen.
   Characteristically there are blast cells.
   Sudan black and peroxidase show the negative reaction.
   Auer rods are absent.

Test value for the layman

Examination of peripheral blood smear and bone marrow is advised:

1. If the patient has high TLC.
2. If the patient has Anemia.
3. If the patient has enlarged lymph nodes.
4. If the patient has weakness and fever.