Chronic Lymphocytic

Leukemia
Chronic Lymphocytic Leukemia (CLL)

 Accumulation of lymphocytes in peripheral blood and bone marrow.

 Lymphocytosis (more than 10*109/L)
 Presence of Smudged cells (Grumpecht bodies).
 Median age is 65.
Normal ranges of differential counts
on aspirated bone marrow

 Myeloblasts (0-4%)
 Promyelocytes (3-12%)
 Neutrophilic Myelocytes (2-13%)
 Metamyelocytes (2-6%)
 Neutrophils (22-46%)
 Eosinophilic Myelocytes (0-4%)
 Basophils (0-1%)
 Lymphocytes (5-20%)
 Monocytes (0-3%)
 Plasma Cells (0-3.5%)
 Megakaryocytes (0-2%)
Cytochemistry
Cytochemistry

Why is it done?
 To characterize the blast cells in acute leukemias as myeloid.

 To identify granulocytic and monocytic components of acute myeloid

leukemia.

 To detect cytoplasmic abnormalities and enzyme deficiencies in myeloid

disorders, example is myeloperoxidase-deficient neutrophils in CML.
Myeloperoxidase

 Myeloperoxidase (MPX) is an enzyme found in the granules of neutrophils

and eosinophils.
 Lymphocytes do not have the MPX activity.
 This stain is useful to differentiates between the blasts of AML from ALL.
 With hydrogen peroxidase, MPX oxidizes the dye and produces black to
red-brown staining.
 Auer rods found in blasts are highly MPX positive.
Myeloperoxidase
Esterases

 This stain is used to differentiate between myeloblasts and neutrophilic

progenitors from cells of monocytic origin.