How to distinguish between leukemia and leukemoid reaction although the two cause an increase in white blood cells?
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Hi Dr.
CML must be differentiated from leukemoid reactions, which usually produce WBC counts lower than 50,000/µL, toxic granulocytic vacuolation, Döhle's bodies in the granulocytes, absence of basophilia, and normal or increased LAP levels; the clinical history and physical examination generally suggest the .
https://www.sciencedirect.com/topics/medicine-and-dentistry/leukemoid-reaction
CML must be differentiated from leukemoid reactions ,which usually produce WBC counts lower than 50,000/µL, toxic granulocytic vacuolation, Döhle's bodies in the granulocytes, absence of basophilia, and normal or increased LAP levels; the clinical history and physical examination generally suggest the ...
https://www.sciencedirect.com/topics/medicine-and-dentistry/leukemoid-reaction
Leukemoid reaction denotes pronounced neutrophilia (>40,000 cells/ml) in acute inflammatory reaction that may be mistaken for leukemia, especially chronic myeloid leukemia. Leukocytosis occurs initially because of accelerated release of cells from the bone marrow and is associated with increased count of more immature neutrophils in the blood (shift to the left). Differentiation of leukemoid reaction and neoplastic leukocytosis includes the following:
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Cells in the peripheral blood in the leukemoid reaction are usually more mature than myelocytes.
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Leukocytic alkaline phosphatase activity is high in a leukemoid reaction but low in chronic myeloid leukemia.
In the leukemoid reaction, the neutrophils are mature and not clonally derived. There is a persistent increase in TLC above 50,000/cmm and no evidence of leukemia. Increased blast cells are not seen in the leukemoid reaction
- A leukemoid reaction is a reactive neutrophilia that occurs in response to an infection, inflammatory process, or malignancy.
- Leukemia is mimicked by the extent of neutrophilia (usually < 35x109/L) and by the presence of circulating immature WBC'S.
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Leukemia is the cancer of blood or bone marrow.
Leukemoid reaction is an increasing in the number if WBC that mimic leukmia and it is not a sign of malignancy.
https://www.labpedia.net/leukemoid-reaction-and-diagnosis-d-d-from-chronic-myelocytic-leukemia/
Hi
https://www.sciencedirect.com/topics/medicine-and-dentistry/leukemoid-reaction
Hi Dr.
https://www.researchgate.net/deref/https%3A%2F%2Fwww.labpedia.net%2Fleukemoid-reaction-and-diagnosis-d-d-from-chronic-myelocytic-leukemia%2F
Hi
https://www.sciencedirect.com/topics/medicine-and-dentistry/leukemoid-reaction
https://www.labpedia.net/leukemoid-reaction-and-diagnosis-d-d-from-chronic-myelocytic-leukemia/
https://www.researchgate.net/deref/https%3A%2F%2Fwww.labpedia.net%2Fleukemoid-reaction-and-diagnosis-d-d-from-chronic-myelocytic-leukemia%2F
All answers are apprpriate but the single most infirmative is LAP. LAP is very high in leukomoid reaction and very low in CML
The term leukemoid reaction is used to describe the occurrence of a peripheral blood picture resembling that of leukemia, because of marked elevation of the total white cells count, or the presence of immature white cells, or both. Leukemoid reactions may be either myeloid or lymphoid.
Myeloid Leukemoid Reaction
Increased of total leukocytes count > 50000/mL and myelocytes and/or myeloblasts appear in the peripheral blood.
Causes
1. Severe infections
2. Secondary to nonhematological malignancy
3. Acute hemolysis.
Clinical Feature
Features related to the causative disorder.
Laboratory Finding
Leukocytes are usually moderately increased but not exceeds 100000/ml
Myelocyte 5-15% and blasts < 5%. Toxic granulation and Doehle-bodies may be seen
Anemia may occur. Plateles are normal to increase, but reduced in leuko-erythroblastic anemia and intravascular coagulation.
Bone marrow: White cell hyperplasia may be present with normal immature cells.
ALP increased (in CML is decreased).
Absence of Philadelphia chromosome
Lymphatic Leukemoid Reaction
Causes
1. Infectious mononucleosis
2. Cytomegalovirus
3. Pertussis, measles, chickenpox
4. Tuberculosis
5. Carcinoma
Leukoerythroblastic Reaction
Presence of immature myeloid cells and nucleated RBC in the peripheral blood.
Causes
1. Secondary carcinoma of bone
2. Myelofibrosis, Thalassemia major, Hemolytic anemia, Multiple myeloma, Lymphoma, Gaucher's and Niemann-pick disease, Marble bone disease.
Blood Film
Anisocytosis, Poikilocytosis (Tearshaped), nucleated RBC (10% of WBC) Reticulocytes > 3%-10%) is usual.
Leukocyte cells show shift to left (Total N-increase but some times decreased). Platelet count is normal or reduced.
Leukemoid reaction is characterized by high NAP (neutrophilic/leucocyte alkaline phosphatase)
Counts high but usually less than 50,000
Platelets-normal to low
PS-toxic granules, cytoplasmic vacuolations and shift to left.
In leukemiod reaction the NAP or LAP score is high while in CML it is low.
Some good ideas and approximate answers to a tricky question.
There is no magic bullet test IMO.
just:
1. clinical history underlying the result ? weight loss, night sweats, lymphadenopathy/spleen, lungs clear, UTI, abcess etc etc
2. Then a blood film - a skill looking for clues in the immature cells , promyelocytes and myelocyes. is there a basophilia? or blasts? Is there intense intra cellular granular (myeloperoxidase) staining of the neutrophils suggesting a reactive picture? Skill required in staining and morphological assessment.
3. Neutrophil alkaline phosphatase (NAP) score may be useful on occasion - but beware of its limitations as a test (5% failure rate) and reliant on the skill of the technician in staining and scoring the test also viability of the reagents. you may need to do more tests.
4. other markers of acute/chronic infection or inflammation - ESR, CRP even Ferritin.
5. If still suspicious and persisting - BCR-ABL to rule out CML.
leukemoid reaction a peripheral blood picture resembling that of leukemia or indistinguishable from it on the basis of morphologic appearance alone, with leukocytosis of varying degrees and increased numbers of immature cells in circulation. It may be seen with infections such as
tuberculosis, brucellosis, toxoplasmosis.
Leukemia ( AML) peripheral blood or bonemarrow picture increases numbers of the immature cell (>20%), pathophysiology hematopoiesis differentiation arrest dan proliferation drive are caused by genetic and cytogenetic abnormal.
Leukemia ( AML) peripheral blood or bonemarrow picture increases numbers of the immature cell (>20%), pathophysiology hematopoiesis differentiation arrest dan proliferation drive are caused by genetic and cytogenetic abnormal.
leukemoid reaction a peripheral blood picture resembling that of leukemia or indistinguishable from it on the basis of morphologic appearance alone, with leukocytosis of varying degrees and increased numbers of immature cells in circulation. It may be seen with infections such as
tuberculosis, brucellosis, toxoplasmosis.
A course of antibiotics will relieve the symptoms and counts if due to infection leading to leukemoid reaction.
In Leukemoid reaction, peripheral smear shows mature neutrophils and bone marrow shows myeloid dysplasia with mature neutrophils. LAP (leukocyte Alkaline Phosphatase) score is high. In leukaemia immature neutrophils occur in peripheral smear and bone marrow. LAP score is low.
As per the details:
Leukaemia is the cancer of blood or bone marrow. Leukemoid reaction is an increase in the number of WBC that mimic leukmia and it is not a sign of malignancy. In the leukemoid reaction, the neutrophils are mature and not clonally derived.