CLINICAL AND HAEMATOLOGICAL EVALUATION OF LEUKAEMIAS, USING CYTOCHEMICAL STAINS AND IMMUNOPHENOTYPING
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 19
Abstract
BACKGROUND Leukaemias are characterised by abnormal proliferation of haematopoietic cells, causing progressive infiltration of the marrow. It is the eleventh most common cancer in the world, and increasingly found now. Two widely used classifications are currently used, the FAB, and the WHO classification, which has got supplanted now, with increasing knowledge on cytomorphology and cytogenetics. This study attempts to evaluate the role of cytochemistry in various types of leukaemias, as well as the role of immunophenotyping in a select few cases, which were referred to the Department of Pathology, at Thanjavur Medical College. We wanted to study, the types and subtypes of leukaemias using cytochemistry, their morphology, the demographic distribution and their clinical and haematological presentation. METHODS The present study had a sample size of 56 cases of leukaemia, diagnosed in the department of pathology, Thanjavur Medical College. Those cases referred to the Department of pathology, with clinical suspicion, were subjected to peripheral smear study by standard Romanowsky stains first, mainly by Leishman’s stain and a presumptive diagnosis was made. Following which peripheral blood smears were subjected to special cytochemical stains using Sudan Black B (SBB) and Periodic Acid Schiff’s reagent stain (PAS). The percentage of blast cells were enumerated, and the cytomorphology studied based on their positive staining effects on the respective blood smears. Thereby, the types and subtypes of leukaemias were classified and reported as per FAB classification. Relevant clinical history was obtained from each case, with parameters relating to splenomegaly, hepatomegaly, and lymphadenopathy. Haematological investigations were done on a three-part automated cell counter, and values pertaining to haemoglobin, total count, and platelet count were also noted. Clinical and haematological correlation was thus made with the diagnosed cases, and statistical analysis was undertaken. In six cases, immunophenotyping using flow cytometry, and standard panel markers, was undertaken; when in doubt, its concordance patterns were also noted. RESULTS 56 cases of leukaemia, identified by morphology and cytochemistry, were seen in the study between January 2015 and June 2015. Cytochemical stains used were Sudan black B, and PAS. Out of the total, 36 cases were acute, rest were chronic cases. AML accounted for 43% of the cases, followed by CML at 33%, and ALL at 22%. A slight female preponderance was seen in the number of AML cases, but a male predominance was seen in ALL. ALL was common in the child age group, followed by AML, and CML in the 21-40 age group, followed by AML. CLL was seen mostly above 40 yrs. of age. Anaemia was more in acute leukaemias especially ALL, followed by AML. Total count values were high in CML, followed by AML. Platelet counts were less in acute leukaemias, especially ALL, followed by AML. Splenomegaly was the commonest feature seen in 21 cases. Immunophenotyping was done in 6 cases, 4 cases were concordant, showing a 67% rate. CONCLUSIONS In a setting where there is a lack of facilities for flow cytometry, as in majority of centres in the developing countries, morphology combined with cytochemistry, still serves as the best means in diagnosing leukaemia cases.
Authors and Affiliations
Abu Arshad Abdu Salaam, Senthil Kumar Mani
Keywords
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- EP ID EP617633
- DOI 10.14260/jemds/2019/348
- Views 75
- Downloads 0
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