LABORATORY FINDINGS OF

LEUKAEMIA

Modul Haematology

Sulistyo M. Agustini
FK-UMM
2009
 PEMERIKSAAN LABORATORIUM…..

Diagnosis Lab awal. o Morphology

Automated hematology analyser
Morphology sel darah &
Bone marrow
o Cytochemistry
o Immunophenotyping
o Cytogenetic analysis

TEKNIK
Cytomorphology & Histomorphology
Diagnosis & Terapi awal Cytochemistry & multiparameter
Resiko tinggi Flow cytometry diagnostic
Prognosa & keberhasilan terapi
Fluorescente in Situ Hibridization (FISH)
Polymerase Chain Reaction (PCR)

Pendekatan biomolekuler & genetika

 hematopoiese

IL-3, GM-CSF

IL-5
 Faktor Predisposisi:
Eksternal:(lingkungn, carsinogen dsb)
Internal: Genetik/molekular (60-75%)

Leukemia akut

ALL AML

Darah rutin &

Histokimia Immunophenotyping Genotyping
Morfologi sel
History of Hematology Cell Counting

Manual
WBC, RBC PLT

Semi Automatis
WBC RBC, PLT

Otomatis
WBC RBC, PLT
Extended RET Information

Slide 6
 Tabel Perbedaan ALL dengan AML

Lymphoblastic Myeloblastic
Size of Blasts Variable, depending onsubtype Usually large & uniform

Cytoplasm Scant Moderate amount

Cytoplasmic granules Absent Frequently present
Auer rod Absent Seen in about 1/5 of case
Nuclear chromatin Coarse to fine Delice & dispersed
Nucleoli 0-2, less prominent 1-4, often promeinent
Myelodysplastic changes Absent May be present
Myeloperoxidase/sudan black negative Often positive

Chloroacetate esterase negative Positive in myeloid leukemia

Nonspecific esterase negative Positive in monocystoid leukemia

Periodic acid-Schiff Oftenpositive Positive in about 10%-15% of

case
Tdt Frequently positive Positive in occasional cases
Common ALL antigen (CD10) Frequently positive Negative

Myeloid antigen Negative Positive

Gene rearrangement Frequently positive Occasionally positive

Tsien Sun (2008)

The diagnose of ALL is classified according to FAB (French
America British) system, which is classified into 3 groups
based on morphology
 L1: Cells are usually small, with scant cytoplasm and inconspicuous
nucleoli. L1 accounts for 85% of all cases of childhood ALL.

Fig 1. L1 morphology
• L2: Cells are larger, than in L1. The cells demonstrate considerable
heterogeneity in size, with prominent nucleoli, and abundant
cytoplasm . L2 accounts for 14% of all childhood ALLs.

Fig 2. L2 morphology
• L3: Cells are large and notable for their deep cytoplasmic
basophilia. They frequently have prominent cytoplasmic vacuolation
and are morphologically identical to Burkitt lymphoma cells . L3
accounts for 1% of childhood ALLs.

Fig 3. L3 morphology

During 2002-2005, 88.5% of our patients are L1 type ALL

and the rest are L2 type ALL.
 B-cell Chronic lymphocytic leukemia
• Incidence
– Western world: most frequent leukemia
2.7/105/yr and rising!
– Asia: less frequent 0.48 - 1.7/105/yr ?*
• Age > 50, median 65 years
• male: female=2:1

• Blood: lymphocytosis

• Monoclonal mature B-cells

– CD19+; weak CD20
– CD5+, CD23+ - Small cells (6-10 um)
– sIg weak - Condensed chromatin
- Smudge cells
– CD22/CD79a weak
– FMC7-
* Japan;Tumura et al: Eur J Hematology 2001
 Chronic myeloid leukaemia (CML)
Laboratory finding
• CLM is clonal disorder of a pluripotent stem cell &
classified as one of the myeloproliferative disorder
• Leucocytosis >50x109/l, sometimes >500x109
• Increased circulating basophils
• Normochromic, normocytic anaemia
• Platelet count may be increased (most frequently),
normal or decreased
• Neutrophil alkaline phosphatase score is invariably low
• Bone marrow is hypercellulr with granulopoietic
predominance
• Philadelphia chromosome(Ph) on cytogenetic analysis of
blood or bone marrow
 Cronic lymphoid leukaemia (CLL)
• Peak incidence between 60 & 80 years of
age
• Leucocytosis >5x109/l, sometimes
>300x109/l
• Immunophenotyping CD 19, CD5 and
CD23
• Normochromic, normocytic anaemia
• Platelet count may be increased (
 PENDAHULUAN

Diagnosis Kelainan Hematologi semakin lama semakin

canggih

Automated Hematology Analyzer Sysmex XT-2000i

More quicker and more reliable

Sysmex XT-2000i
Cerdas, cepat dan akurat
Dalam menentukan diagnosis kelainan hematologi baik
yang berasal dari lekosit, eritrosit dan trombosit

Sysmex XT-2000i tiada duanya…..

KOLOM-KOLOM PADA SYSMEX XT-2000i

1. Analysis data
2. DIFF scattergram
3. WBC/BASO scattergram
4. RET scattergram
5. PLT-O scattergram
6. RBC histogram
7. PLT histogram
8. WBC system IP message
9. RBC/RET system IP message
10. PLT system IP message
Sample Normal pada Sysmex XT-2000i

WBC IP Message RBC/RET IP Message PLT IP Message

Abnormal Pattern Pada Sysmex XT-2000i
 IP Messages List

WBC IP Message RBC/RET IP Message PLT IP Message

Perhatikan terdapat 3 IP Messages list ialah

• WBC IP Message list
• RBC IP Message list
• PLT IP Message list
(IP Message list adalah penting sekali untuk membantu menegakkan diagnosis)
 WBC IP Message List

Abnormal
Abnormal
Suspect
WBC Abn Scattergram
Suspect
Neutropenia
Blast
Neutrophilia
Immature Gran
Lymphopenia
Left Shift
Lymphocytosis
Atypical Lympho
Monocytosis
Abn Lympho/Blast
Eosinophilia
NRBC
Basophilia
RBC Lyse resistance
Leucocytopenia
Leucocytosis
 RBC IP Message List

Abnormal
Suspect
RBC Abn Distribution

Dimorphic Population RBC Agglutination

RET Abn Scattergram Turbidity/HGB Interference

Reticulocytosis Iron Deficiency
Anisocytosis
Microcytosis HGB Defect
Macrocytosis
Hypochromia Fragments
Anemia
Erythrocytosis
 PLT IP Message List

Abnormal

PLT Abn Scattergram

PLT Abn Distribution

Thrombocytopenia
Thrombocytosis

Suspect

PLT Clumps
PLT Clumps (S)
CARA MEMBACA SYSMEX XT-2000i

WBC IP Message RBC/RET IP Message PLT IP Message

Perhatikan items yang penting

• WBC
• RBC-HGB-HCT-PLT
• Neut-lymph
• IP Messages
• Sitogram - Histogram
Sysmex XT-2000i untuk Diagnosis Kelainan Lekosit

Kelainan Lekosit

Jumlah lekosit rendah (Lekopeni)

Jumlah lekosit tinggi

Lekositosis Leukemia

Akut (ALL, AML, MDS)

Kronik (CLL, CML)

 Lekopeni Pada XT-2000i

WBC IP Message RBC/RET IP Message PLT IP Message

WBC rendah yang lain dalam batas normal

Pada WBC Message terdapat leucocytopenia
Lekopenia sering terjadi pada infeksi virus dan bila disertai trombositopenia
kemungkinan adalah demam berdarah atau penyakit hati kronis
 Lekositosis Pada XT-2000i

WBC IP Message RBC/RET IP Message PLT IP Message

WBC dan Neut meningkat yang lain dalam batas normal

Pada WBC Messages terdapat leucocytosis
Lekositosis sering terjadi akibat infeksi bakteriil
 AML Pada XT-2000i

WBC Meningkat, HGB rendah, PLT rendah

Terdapat Blast pada WBC Message dan Sitogram DIFF
IG positif pada WBC Message
Hapusan Darah Pada AML
 ALL Pada XT-2000i

WBC meningkat, HGB rendah, PLT rendah

Pada IP Messages terdapat leucytosis, blast, anemia dan thrombocytopenia
Tidak terdapat IG
Terdapat Blast pada sitogram DIFF
Hapusan Darah Pada ALL
 CML Pada XT-2000i

WBC meningkat, HGB menurun ringan, PLT meningkat

Pada IP Messages terdapat leucocytosis, IG, anemia dan platelet Clump
IG dan Blast tampak pada sitogram DIFF
Hapusan Darah Pada CML