Page 411 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 21 ■ Acute Leukemias 395

TABLE 21.11 Periodic Acid–Schiff (PAS) Reactions

Cell Type Reaction

Positive reactions *

Neutrophilic granulocytes except blast forms Strongly positive

Megakaryoblasts in malignant or proliferative disease; both Strongly positive

blasts and megakaryocytes are strongly positive

Erythrocytes in erythroleukemia (FAB M6) Strongly to moderately positive

Variable reactions

Eosinophils, basophils Granules are negative; cytoplasm may contain faintly positive
(PAS) granules

Monocytes Faint pink cytoplasm, with or without granules

Lymphocytes May contain a few pink or red granules

Thrombocytes Intense pink or red

Megakaryocytes Diffuse pink or red; may have coarse red granules

Lymphoblasts (leukemic) 30%–40% may show strong coarse or block-like positivity

Negative reaction

Erythrocytic series Negative

Myeloblasts and monoblasts Faint diffuse reaction may be occasionally observed

* Appear as a diffuse pink or large red aggregate of particles.

REA MEN OP IONS m m m k m -

, k . T

G AML m m m

m . R m m k . T

k m m m , BCR-ABL

m k k m m % P -

( . ). O , m j (P ) CML % % (P ) ALL.
+
+

TABLE 21.12 Cytochemical Reactions in Selected Leukemias

FAB Class SB MPO PAS NASDCA (α) NA (7.6) Acid Phos

M1 myeloid + + − − − −

M2 myeloid ++ ++ − + − −

M4 myelomonocytic ± ± − ± ++ −

M5 monocytic ± ± ++ − ++ –

M6 erythrocytic − − + + +++ −

M7 megakaryocytic − (+) * + + +++ −

L1 or L2 (T-ALL) − − ± − − (++) †

* Test is performed on un xed preparation.

† The reactivity must be focal or Golgi in nature.

FAB, French-American-British Cooperative Group Classi cation; SB, Sudan black B; MPO, myeloperoxidase; PAS, periodic acid–Schiff; NASDCA, naphthol AS-D

chloroacetate esterase; (α) NA, alpha-naphthyl acetate esterase; Acid Phos, acid phosphatase.

Note: Negative reactions for all tests, except for the PAS, indicate common acute lymphoblastic leukemia, pre-B or B-cell lymphoblastic leukemia, or unclas-

si ed acute lymphoblastic leukemia.