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TRAP- hairy cell

Myeloperoxidase-

myeloblastic and monocytic AML

Quick Guide to Cytochemistry

L1 and L2 stain positive for PAS- "block staining"

cyanide-resistant peroxidase-

eosinophils

PAS- M6 only in AML

SBB pos- except M0

will be neg for:

-peroxidase

-myeloperoxidase

-cyanide-resisitant peroxidase

-Sudan Black

Will be positive for:

-TdT

NSE pos:

-monocytes, megakaryocytes

SE pos:

- all myelocytic

Peroxidase-

primary myloid, platelets, and eos

NSE pos in some T lymphs

combined esterase evalulate monocytic to myelocytic lines

AML

ALL

Stains:

Peroxidase and sudan black (=)- lymphoid lineage

TdT (+)

Good Prognosis

15-25% of all ALL

present with: medialstinal mass, very high WBC count, and hepatosplenomegaly

males more than females

CD markers:

CD5: bad prognosis

CD3: worse prognosis

t(1;14)

T Cell Acute Leukemia

Anemia: N/N with thrombocytopenia and PREDOMINANCE OF BLASTS

FAB: L1

Must know markers:

- t (12;21) TEL-AMLI and expression of CD 10 and CD19 (not 20)

(memory tip: TEL-AMLI is inverse 12,21 CD markers: 10 + 19 does not equal 20)

B Cell Acute Leukemias

(memory tip: if you do that classic Catholic cross gesutre you make a T- Tcell- right at your mediastinum)

Stains:

TdT (+)

pre-B cell

Hint: although an ALL, this is observed with mature B-lymphs and will therefore be in the mature lymph section

WHO classification

B cell (Burkitts)

T Cell

ALL

Hematopoetic Stem Cell

Early Pre-B Cell Lymphoblastic Leukemia

Lymphoblast

Myeloblast

Memory tool:

ALL kids get ALL

- ALL is found in children 75% of the time

Look at those Auer Rods!

Acute Lymphoblastic Leukemia

Rare

Proliferation in BM: >50% blasts are megakaryocytic in origin

PAS usually pos

MPO, SBB neg

>30% WBC are myeloblast

>50% of nucleated bone marrow cells are erythroid precursors

Proliferation in marrow of megaloblstoid erythroblasts

N/N anemia

with weird nucleated RBC

PAS stain pos

Both megakaryocyteand erythrocytes originate from a myeloid precursor and are therefore classified as AML

M1-

minimal differentiation

15% of adult cases of AML

Sudan black (+), peroxidase (+), 20% NSE (+)

M0-

no definitive differentiation

CD33, CD13, CD117

NSE (=), myelo peroxidase (=), Sudan black (=)

M2-

some maturation *>10% immature cells are promylocyte or older

25% of adult cases- most common

favorable prognosis:

CD 13, 33, 117 (rule of 3s and 7s) and 19, 34, 56

Translocation of t(8;21)

Acute Myeloid Leukemia

M6:

Erythroleukemia or DiGuglielmos

Auer Rods begin!

M7:

Megakaryoblastic Leukemia

Poor prognosis

Memory hints:

M0= 0 defining characteristics

CD markers- rules of 3s and 7s

Promyelocyte

>30 % non-erythroid cells are pros (often have auer rods)

often presents with signs and symptoms of DIC (and thrombocytopenia included)

10% of all adult

Markers: Has rule of 3s and 7s but lacks HLA-DR and 34

M3

check D-dimer

Memory hint: DIC is a deadgivaway for M3

Myelocyte

Myelocytic and monocytic differentiation

CD Markers: rule of 3s and 7s, 11, 14, 64, 4

Muramidase is increased

M4Eo- immature eos in bone marrow

>80% of WBC are from monocytic line

--auer rods still possible

anemia and thrombocytopenia

Peroxidase (=), Sudan black (=), NSE (majority +),

Most often die before treatment

Memory hint: rules of 3s and 7 changes to 3s, 7s, and 4s for M4

Helpful hint: SE compared to NSE will confirm

M4:

Acute Myelomonocytic

M5:

Acute Monocytic

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