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Mediastinal mass in T-ALL.

• Immunophenotyping of blood or marrow blasts.

• Total WBC usually high with blast cells on film but may be low (previously known as aleukaemic leukaemia).

• Hb, neutrophils and platelets often low and clotting may be deranged.

• Bone marrow heavily infiltrated with blasts (>20%).

• CXR and CT scan needed if ALL has B-cell or T-cell phenotype for abdominal or mediastinal lymphadenopathy respectively.

• Lumbar puncture mandatory to detect occult CNS involvement but may be postponed until treatment reduces high peripheral blast count to prevent seeding (Note—fundoscopy, CT head scan and platelet transfusion usually required).

Bone marrow: lymphoblasts in ALL L1.

Bone marrow: lymphoblasts in ALL L3.

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