Leukemia must be distinguished from reactive leukocytoses and
from cytopenias such as aplastic anemia. For instance, in a child,
acute lymphoblastic leukemia (ALL) must be distinguished from
a viral lymphocytosis.
The type of leukemia has prognostic and theraputic significance.
Of the acute leukemias, ALL has a much better prognosis than acute
myeloblastic leukemia (AML).
The diagnosis and clasification of leukemia is
accomplished largely through the laboratory examination of
peripheral blood and bone marrow.
The principle studies include:
peripheral blood smear
bone marrow aspirate & biopsy
Genetic analyses-chromosomal and molecular
The initial laboratory evaluation of a suspected leukemia requires
a complete blood count (CBC) including a platelet count and an
examination of a peripheral blood smear.
Although the white blood cell count (WBCc) is typically
thought of as being greatly increased in leukemia, the WBCc is
really highly variable, ranging from severe leukopenia to extreme
The platelet count is generally decreased in acute
leukemias, but is often normal in chronic leukemias.
The hematocrit and hemoglobin usually
reflect a normocytic/normochromic anemia.
This image shows a pair of microcapillary
tubes following spining in a centrifuge. Three distinct layers
can be seen, a red cell layer, a white cell/platelet layer,
and a plasma layer.
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