Leukaemoid Reaction Lecture by DR

Leukaemoid Reaction
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Learning Objectives
● Introduction
● Definition of Leukaemoid Reaction
● Types of Leukaemoid Reaction
● Myeloid Leukaemoid Reaction
● Lymphoid Leukaemoid Reaction
Introduction
Leukaemoid Reaction
Leukaemoid Reaction
Leukaemoid Reaction
● “oid” suffix means “resembling”
● Here peripheral blood resembles leukaemia.
● The patient does not have leukaemia.
Definition of Leukaemoid Reaction
● A reactive excessive leucocytosis in the peripheral

blood resembling that of leukaemia in a subject
who does not have leukaemia.

● Reference:
Mohan, H., 2018. Textbook of pathology. Jaypee Brothers, Medical
Publishers Pvt. Limited.

● Reference:
Mohan, H., 2018. Textbook of pathology. Jaypee Brothers, Medical
Publishers Pvt. Limited.

● Reference:
Mohan, H., 2018. Textbook of pathology. Jaypee Brothers, Medical Publishers
Pvt. Limited.
● The clinical features of leukaemia such as splenomegaly,
lymphadenopathy and haemorrhages are usually absent.
● A leukemoid reaction is defined by a WBC count more than 50
× 109/l and it resembles leukemia but arises from other causes
such as infection or cancer.
● A leukemoid reaction is defined by a WBC count more than 50
× 109/l and it resembles leukemia but arises from other causes
such as infection or cancer.
● Reference:
Porwit A, McCullough J, Erber WN. Blood and Bone Marrow Pathology E-
Book: Expert Consult: Online and Print. Elsevier Health Sciences; 2011 May
27.
Types of Leukaemoid Reaction
● Lymphoid Leukaemoid Reaction
Myeloid Leukaemoid Reaction
● Blood picture resembles either acute or chronic
myeloid leukaemia.
● Blood picture resembles either acute or chronic
myeloid leukaemia.
● Marked neutrophilic leucocytosis with presence
of premature white cells of all stages may
mimic chronic myeloid leukaemia (CML).
● Causes:
– Severe bacterial Infections
– Intoxication
– Malignant disease
– Severe acute haemolysis
– Severe haemorrhage
-- staphylococcal
staphylococcalpneumonia
pneumonia
-- disseminated tuberculosis
disseminated tuberculosis
● Causes: -- endocarditis
endocarditis
-- sepsis
sepsis
– Severe bacterial Infections -- meningitis
meningitis
-- diphtheria
diphtheria
– Intoxication
– Severe acute haemolysis
-- staphylococcal
pneumonia
endocarditis
-- sepsis
sepsis
meningitis
-- diphtheria
diphtheria
– Intoxication
– Severe acute haemolysis --mercury

mercurypoisoning
poisoning
--severe burns
severe burns
--eclampsia
eclampsia
-- staphylococcal
pneumonia
endocarditis
-- sepsis
sepsis
meningitis
-- diphtheria
diphtheria
– Intoxication
– Severe acute haemolysis --mercury

mercurypoisoning
poisoning
--severe burns
severe burns
--eclampsia
eclampsia
--multiple
multiplemyeloma
myeloma
--myelofibrosis
myelofibrosis
--bone
bonemetastasis
metastasis
--Hodgkin’s
Hodgkin’sdisease
disease
Laboratory Diagnosis of
● Moderate leukocytosis, not exceeding 100,000/μl.l.
● Dominant white blood cells are neutrophils.
● Other white blood cells include immature cells, predominantly metamyelocytes
and myelocytes consisting 5-15% and myeloblasts fewer than 5% in the peripheral
blood smear.
● Basophils are normal.
● Toxic granulation and Döhle bodies may be seen in the cytoplasm of neutrophils
in infective cases.
● NAP score is elevated.
● Cytogenetic studies may be used in exceptional cases.
● Toxic granulations
– Purple or dark-blue staining azurophilic granules in the
cytoplasm of neutrophils, bands and metamyelocytes.
– Results from an abnormality in the maturation of the
primary granules leading to retention of their
azurophilic property.
● Toxic granulations
Segmented
Toxic granulations Nucleus
Neutrophil
● Döhle bodies
– Small, round to oval, grayish-blue cytoplasmic
inclusions seen in the peripheral part of cytoplasm of
neutrophils.
– Thought to be remnants of the rough endoplasmic
reticulum.
● Döhle bodies
Segmented
Döhle bodies Nucleus
Fine Granules
Neutrophil
Lymphoid Leukaemoid Reaction
● Peripheral blood picture resembles that of
acute or chronic lymphoid leukaemia.
● Causes:
– Infections
– Malignant diseases
● Causes: Infectious mononucleosis
Cytomegalovirus
Whooping cough
Chicken pox
Measles
– Infections Tuberculosis
Infectious lymphocytosis
– Malignant diseases
● Leucocytosis not exceeding 100,000/μl.l.
● Differential white cell count shows mostly
mature lymphocytes simulating the blood
picture found in cases of Chronic Lymphocytic
Leukaemia (CLL).
Differences Between Myeloid Leukaemoid Reaction & CML
Features Myeloid Leukaemoid Reaction CML
TLC Not higher than 100,000/μl.l ≥ 100,000/μl.l
DLC Basophils normal Basophilia present
NAP score Elevated Reduced
Philadelphia Absent Present

chromosome
ABL-BCR fusion Absent Present

gene
Organ infiltration Absent May be present


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Leukaemoid Reaction

● A reactive excessive leucocytosis in the peripheral

● A reactive excessive leucocytosis in the peripheral

● A reactive excessive leucocytosis in the peripheral

● A reactive excessive leucocytosis in the peripheral

– Severe acute haemolysis

– Severe acute haemolysis

– Severe acute haemolysis --mercury

– Severe acute haemolysis --mercury

TLC Not higher than 100,000/μl.l ≥ 100,000/μl.l

DLC Basophils normal Basophilia present

NAP score Elevated Reduced

Philadelphia Absent Present

ABL-BCR fusion Absent Present

Organ infiltration Absent May be present

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