DR Medhat MRCP

• Diagnosis:
CBC : leucocytosis (common finding but not a must).
Peripheral blood film : > 30% blasts are almost diagnostic of AML.
BM biopsy (defenitive diagnostic method):
- Auer rode : is an eosinophilic needle-like inclusions in the cytoplasm of blast
Cells (pathognomonic of AML).
The combination of a myeloperoxidase or Sudan black stain and a nonspecific
esterase (NSE) stain will provide distinction of AML from ALL and in
subclassification of AML in most cases.
• MO
• M1
• M2
• M3
• M4
• M5
• M6
• M7
Undifferentiated
Without maturation
With granulocytic maturation
Acute promyelocytic
Granulocytic and monocytic
maturation
Monocytic
Erythroleukemia
Megakaryoblastic
M4 is NSE +ve
M5 is strongly +ve for NSE
M6 is PAS stain +ve
- Differentiation is not important in MRCP exam except acute promyelocytic leukemia
(APML, the M3 subtype of AML).
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Acute Promyelocytic Leukemia (APL) M3
Associated with t(15:17).
Fusion of PML and RAR- α genes
Presents younger than other types of AML (average = 25
years old).
C/P : chest infection , WBCs , platelets & DIC (common)
TTT : ATRA + induction chemotherapy.
Prognosis : good [t(15 : 17)],curable with TTT
Complications of TTT : DIC (due to release of promyelocytes
contents of granules).
ATRA (All trans retinoic acid)
- Oral cytotoxic ttt
activates RAR-α gene
thus helps the WBCs to
differentiate (i.e
mature)but it will not
eliminate leukemia.
• Poor prognostic features of AML :
1) Age > 60 years.
2) > 20% blast cells after 1 st course of chemotherypy.
3) Cytogenics : deletion of chromosome 5 or 7 (the single most important test for
سؤال prognosis)
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