Topic 3: Leukemoid Reaction

Learning Objectives

At the end of this topic, students will be able to:

1. Differentiate leukemia from leukemoid reaction in terms of their respective

causes.
2. Explain a leukemoid reaction.

Presentation of Contents

LEUKEMOID REACTION

- an excessive leukocytic response in the peripheral blood

- Leukocytosis of 50 X 10 9 /L or higher
- not a disease but only a description
- not related to leukemia

May be due to:

- Infections
- Inflammations
- Intoxications
- Tumors

Leukemoid reaction may be differentiated from CML / CGL by:

“LEUKOCYTE (NEUTROPHIL) ALKALINE PHOSPHATASE ACTIVITY TEST”

Principle:
Increased LAP activity can be observed in neutrophils that have undergone
normal growth.

*Leukemoid reaction = normal growth of neutrophils = INCREASED LAP

SCORE
* Leukemia = malignant growth of neutrophils = DECREASED LAP SCORE

KAPLOW’S METHOD :
Principle: It depends on the hydrolysis of sodium alpha naphthyl phosphate by
alkaline phosphatase to produce a colored precipitate with a diazotised
amine

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 - A total of 100 mature neutrophils are scored from 0 (negative) to 4
(positive), based upon the intensity of the staining reaction
- Reddish-brown to black granules of alkaline phosphatase granules in
cytoplasm of neutrophils
- Normal Kaplow’s Score: 15 – 100
<15 = true leukemia
within N or >N = LR only

LAP Score:
Count 100 consecutive segs and bands
Score:
0 = no reddish brown - black granules
1+ = occasional diffused red-brown-black granules
2+ = moderate number of granules
3+ = many strongly positive granules
4+ = very heavily positive granules

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 Distinction of CML from a Leukemoid Reaction:
Characteristic CML LR
Known cause for leukemoid Absent Often present
reaction
WBC count Often >70,000/u L (High) Usually <70,000/ L (High)
Leukocyte differential Complete spectrum of Predominance of mature
granulocyte precursors neutrophils; rare immature
granulocytes

Shift to the left with blasts, Shift to the left (blasts rare),
eosinophilia, basophilia toxic granulation, Döhle
bodies
Basophilia Present Absent
LAP score Decreased Normal or increased
Splenomegaly Present Absent
Involvement of platelets May be increased Normal morphology and
Giant, hypogranular, and or number
bizarre forms
Anemia Present Absent
Philadelphia chromosome Usually positive Negative

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