Page 470 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

454 PART 6 ■ Neoplastic Disorders

FIGURE 23.5 Ch r cteristic peripher l bloo s e r o chronic

yelogenous leuke i shows b sophili n gr nulocytosis

with neutrophils n i ture gr nulocytes. (Reprinte ro
McCl tchey KD. Clinical Laboratory Medicine, 2n e , Phil elphi ,

PA: Lippincott Willi s & Wilkins, 2002, with per ission.)

FIGURE 23.4 Chronic yelogenous leuke i . Most o the cells in nu bers o i ture or s. Myelobl sts r rely excee
this f el re ture gr nulocytes (b n or s n seg ente neu-

trophils). An incre se nu ber o pl telets (thro bocytes) is lso 5% o the nucle te cells. Eosinophils n b sophils y

seen in this f el o the s e r. (Si ul tes gnif c tion 1,000×.) lso be incre se . T ro bocytosis y be observe in
40% o p tients, lthough thro bocytopeni o en ensues.

Nucle te erythrocytes n re bloo cells exhibiting niso-
co plic tions re rel te to thro bocytopeni , i p ire

pl telet unction, n low intr pl telet concentr tions o bet cytosis n b sophilic stippling c n be seen.

thro boglobulin n pl telet ctor 4 (PF4). P tients experiencing the ter in l ph se o CML y enter
bl st crisis, which is in istinguish ble ro cute yelog-

enous leuke i , p rticul rly the FAB M2 type. Approxi tely
Laboratory Data
30% o p tients h ve cytologic l e tures o CLL.

Cellular Com ponents Ex in tion o bone rrow (Fig. 23.6) biopsy speci en

Te chronic leuke i s re usu lly ch r cterize by the pres- reve ls hypercellul rity with pro inent gr nulocytic hyper-
ence o leukocytosis. In the c se o CML, the egree o leuko- pl si . An incre se nu ber o yeloi cells in the inter e i-

cytosis is extre e. In ition, CML c n lso be i entif e by te st ge is seen. T e yeloi -erythroi (M:E) r tio c n be s
the presence o the entire spectru o i ture n ture high s 25:1. T e bone rrow y beco e f brotic l te in the

yelogenous cells in the bloo n rrow. ise se n y be ist ken or primary myelo brosis (PMF).
Ane i is co on f n ing. T e tot l leukocyte count

is usu lly gre ter th n 50 × 10 /L n y excee 300 × Cytochem istry
9
10 /L. Peripher l bloo s e rs (Figs. 23.4 n 23.5) e - Cytochemistry is use less requently or chronic leuke i s
9

onstr te incre se nu bers o ture gr nulocytic or s, th n or cute leuke i s. In speci l c ses, however, these st ins
such s seg ente neutrophils n b n or s, n s ller y be o i gnostic v lue. T e leukocyte alkaline phosphatase

FIGURE 23.6 Chronic yelogenous leuke i .

A: Peripher l bloo . B: Bone rrow. (Reprinte

H n in RI, et l. Blood: Principles and Practice o
Hematology, 2n e , Phil elphi , PA: Lippincott

Willi s & Wilkins, 2003, with per ission.)