How can you tell if this is leukemia or leukamoid?

[chillaxbro]

How can you tell from just CBC findings like this?

I know alk phos is elevated in leukemoid and low in CML.

Thanks

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[Cytarabine]

You can't. You need additional information and/or tests

 

[worldbeater]

I know alk phos is elevated in leukemoid and low in CML.

This is the best way to distinguish between the two, usually they will stick in the LAP(leukocyte alkaline phosphatase) at the end of the vignette; that will give you a good direction on which way to go.

 

[chillaxbro]

I see...

I vaguely remember another question that referred to the % of immature vs mature cells. That's why I thought you could tell from the CBC. Any idea what I'm talking about?

 

[Cytarabine]

I see...

I vaguely remember another question that referred to the % of immature vs mature cells. That's why I thought you could tell from the CBC. Any idea what I'm talking about?

We talk about I:T (immature to total) ratio in pediatrics as an indicator of sepsis, but not as a distinguishing feature of infection vs malignancy

 

[zhopv10]

So I had forgotten this so i was just reading about it on the european journal of internal medicine (they had a nice review looking at etiologies, diagnostics etc.). And it says of course that a leukamoid rxn by definition is WBC's over 50k and a diagnosis of leukemia has been ruled out. (i'm sure you all knew that). Now the LAP was brought up earlier but this article says that can differentiated LR from CML as well as a lack of immature cells and no bcr/abl translocation. But the lack of increased LAP and all the other things cannot distinguish it from CNL (chronic neutrophilic leukemia). It says later however that the underlying cause is generally fairly apparent from the hx, PE, imaging, and lab studies. So kind of interesting as more of an aside. I think for boards CNL is so rare that we could use the LAP as an actual differentiator but in real life it seems there might be something more to it. Anyway, just thought I'd share lol. Here is the article if any one else wants it, it's free: http://www.ejinme.com/article/S0953-6205(06)00163-4/abstract

 

[okokok]

I see...

I vaguely remember another question that referred to the % of immature vs mature cells. That's why I thought you could tell from the CBC. Any idea what I'm talking about?

Yeah, I had that question recently if we're thinking of the same one. It said that in CML you have a ton of metamyelocytes (>30% I think) and a bit of basophilia and eosinophilia. In AML, you have many more myelocytes and no baso/eosinophilia. Whereas regular leukamoid reaction will have increased ALP as everyone said and the breakdown of neutrophils will be normal. I can look up the question id tomorrow morning if you're interested.

 

[okokok]

Yeah, I had that question recently if we're thinking of the same one. It said that in CML you have a ton of metamyelocytes (>30% I think) and a bit of basophilia and eosinophilia. In AML, you have many more myelocytes and no baso/eosinophilia. Whereas regular leukamoid reaction will have increased ALP as everyone said and the breakdown of neutrophils will be normal. I can look up the question id tomorrow morning if you're interested.

@chillaxbro

The q ID is 1569. I had the explanation slightly wrong. According to UW:

-Leukamoid & CML both have >50k WBCs
-Leukamoid has increased LAP
-CML does not have increased LAP and has a predominance of myelocytes (not metamyelocytes like I said before). This is called the "myelocytic bulge". Eosinophilia & basophilia are present. Immature blast cells like myeloblasts and promyelocytes are <2%.
-AML has a lower WBC count than in CML (AML: 15k - 20k; CML: >50k) and will have a significant increase in blast cells (>20%) not myelocytes like I said. Sorry.

The CBC they give for CML is:
Leuks 58k
-Neuts 42%
--Myelocytes 30%
--Metamyelocytes 8%
--Bands 1%
--Blasts 1%
Eosinophils 6%
Basophils 4%

 

[chillaxbro]

@chillaxbro

The q ID is 1569. I had the explanation slightly wrong. According to UW:

-Leukamoid & CML both have >50k WBCs
-Leukamoid has increased LAP
-CML does not have increased LAP and has a predominance of myelocytes (not metamyelocytes like I said before). This is called the "myelocytic bulge". Eosinophilia & basophilia are present. Immature blast cells like myeloblasts and promyelocytes are <2%.
-AML has a lower WBC count than in CML (AML: 15k - 20k; CML: >50k) and will have a significant increase in blast cells (>20%) not myelocytes like I said. Sorry.

The CBC they give for CML is:
Leuks 58k
-Neuts 42%
--Myelocytes 30%
--Metamyelocytes 8%
--Bands 1%
--Blasts 1%
Eosinophils 6%
Basophils 4%

Exactly what I was looking for, thanks!

 

[worldbeater]

Also to add for leukamoid reaction, they will present with mature neutrophils aka Dohle bodies (World Q), came across it today.