Features

Notes

• Acute leukemias commonly involve CSF (ALL>AML)
• Chronic leukemias rarely involve CSF, except in blast crisis.
• Difficulty in diagnosing if few cells/ post-therapy degenerative changes present.
• Repeat sampling may be necessary.
• May need flow cytometry or immunocytochemistry.

Cellular features

• Depends on type of leukemia
• Cellularity varies
• Malignant cells usually larger than normal lymphocytes
• Cytoplasm usually scant, blue (on DQ stain) and may show vacuoles
• Azurophilic granules and auer rods may be (rarely) visible in myeloblasts

Nuclear features

• Nuclei enlarged
• High N:C ratios
• May have lobulated irregular nuclei
• Chromatin usually fine and powdery in blasts
• Nucleoli visible to prominent
• Multiple nucleoli may be seen in myeloblasts