Page 342 - Concise Pathology for Exam Preparation ( PDFDrive )

12 Haematology 327

Myeloblasts
with 2–5
conspicuous
nucleoli

FIGURE 12.6. PBS from AML showing numerous myeloblasts (larger cells, 12–20 microns in
size with a low N/C ratio, spongy, skein-like chromatin; 2–5 distinct nucleoli; regular nuclear
margins).

Q. Define subleukaemic or aleukaemic leukaemia.

Ans. In some patients with acute leukaemia, the total leukocyte count is normal or less
than normal but abnormal cells are seen in the peripheral blood; this is termed subleu-
kaemic leukaemia. In about 10% of the patients with acute leukaemia, total leukocyte
count is normal or less than normal and there are no abnormal cells in the peripheral
blood. This is called aleukaemic leukaemia. Diagnosis is confirmed by examining the
bone marrow, which shows a larger number of leukaemic cells.

Q. Discuss the clinical features and laboratory diagnosis of chronic
myeloid leukaemia (CML).

Ans. CML is a myeloproliferative disease characterized by excessive proliferation of my-
eloid cells with near normal maturation.

Natural Course
The disease has three phases:
1. Chronic stable phase
Symptoms
• Peak incidence in 4th and 5th decades
• Patients may be asymptomatic in the early stage. Symptoms are mainly due to mas-
sive splenomegaly, anaemia and a hypermetabolic state.
• Symptoms due to massive splenomegaly include abdominal distension, dyspepsia,
flatulence, reflux oesophagitis, dyspnoea and dragging discomfort in the left hypo-
chondrium.
• Hepatomegaly may be seen.
• Symptoms resulting from the hypermetabolic state include fever, weight loss, night
sweats and heat intolerance.
• Anaemia manifests as fatigue, weakness and anorexia.
• Priapism (high counts leading to obstruction of flow in the corpus cavernosum) may
be seen.
• Bleeding tendencies occur late.

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