Diagnosis Of Acute Leukemias

Morphologic examination of the Romanowsky-stained bone marrow and peripheral blood smears as well as cytochemical stains is the method used to identify subtypes of acute leukemia. The initial intent was to separate acute lymphoblastic leukemia (ALL) and AML into easily identifiable cell types. An essential cytochemical stain is one that demonstrates myeloper-oxidase (MPO), an enzyme restricted to the primary granules of the granulocytes and monocytes.8 Acute leukemias are traditionally classified by a combination of morphologic and cytochemical features on the basis of criteria of the French-American-British (FAB) Cooperative Group. However, the addition of acute megakaryoblastic leukemia9 and the minimally differentiated acute myeloid leukemia10 went beyond morphology and cytochemistry to include cell phenotype. The distribution of the FAB cell types is indicated in Table 14-1. At diagnosis, mor-

Table 14-1. Classification of the Acute Leukemias

Morphological

Subtypes

Type

(Common Terms)

Lymphocytic

ALL (FAB)

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