Electron Microscopy

Although immunophenotyping studies have largely replaced ultrastructural analysis, electron microscopy (EM) still provides valuable information to demonstrate either MPO or platelet peroxidase (PPO). These ultrastructural studies are useful in the confirmation of myeloid (MO) or megakaryocytic (M7) origin of blasts. MPO can be demonstrated by electron microscopy in blast cells that previously had negative results (less than 3 percent positive blasts) by conventional criteria. Although immunophenotyping studies have largely replaced ultrastructural analysis, it is still useful to define the myeloid component in biphenotypic leukemias.66,67 In megakaryoblasts, the PPO reaction is localized exclusively on the nuclear membrane and the endoplasmic reticulum, whereas in myeloblasts it occurs in the Golgi area and cytoplasmic granules.

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