Chronic myelogenous leukemia differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
Chronic myelogenous leukemia must be differentiated from leukemoid reaction, chronic neutrophilic leukemia, and acute myeloid leukemia.[1]
CML must be differentiated from leukemoid reactions, which usually produce white blood cell counts lower than 50 3 109/L, toxic granulocytic vacuolation, Dohle’s bodies in the granulocytes, absence of basophilia, and normal or increased LAP levels. The clinical history and physic al examination generally suggest the origin of the leukemoid reaction. Corticost eroids can rarely cause extreme neutrophilia with a left shift, but this abnor mality is self-limited and of short duration. CML may be more difficult to differentiate from other myeloproliferative or myelodysplastic syndromes. Patients with agnogenic myeloid metaplasia with or without myelofibrosis frequently have splenomegaly, neutrophilia, and thrombocytosis. Polycythemia vera with associated iron deficiency, which causes normal hemoglobin and hematocrit values, can manifest with leukocytosis and thrombocytosis.Such patients usually have a normal or increased LAP score, a WBC count <25 3 109/L, and no Ph chromosome. The greatest diagnostic difficulty lies with patients who have splenomegaly and leukocytosis but do not have the Ph chromosome. In some, the BCR-ABL hybrid gene can be demonstrated despite a normal or atypical cytogenetic pattern. Patients who are Ph negative and BCR-ABL negative are considered to have Ph-negative CML or chronic myelomonocytic leukemia. Rarely, patients have myeloid hyperplasia, which involves almost exclusively the neutrophil, eosinophil, or basophil cell lineage. These patients are described as having chronic neutrophilic, eosinophilic, or basophilic leukemia and do not have evidence of the Ph chromosome or the BCR-ABL gene. Isolated megakaryocytic hyperplasia can be seen in essential thrombocythemia, with marked thrombocytosis and splenomegaly. Some patients who present with clinical characteristics of essential thrombocythemia (with marked thrombocytosis but without leukocytosis) have CML; cytogenetic and molecular studies showing the Ph chromosome, theBCR-ABL rearrangement, or both lead to the appropriate diagnosis and treatment. PMID:24729196
Differential Diagnosis
Chronic myelogenous leukemia must be differentiated from:[1][2][3]
- Leukemoid reaction associated with:
- High leukocyte alkaline phosphatase
- White blood cell counts lower than 50 × 10^9/L
- Döhle's bodies in the granulocytes
- Absence of basophilia
- Basophils and eosinophils are almost always increased in chronic myelogenous leukemia
References
- ↑ 1.0 1.1 Gajendra S, Gupta R, Chandgothia M, Kumar L, Gupta R, Chavan SM (2014). "Chronic Neutrophilic Leukemia with V617F JAK2 Mutation". Indian J Hematol Blood Transfus. 30 (2): 139–42. doi:10.1007/s12288-012-0203-6. PMC 4022913. PMID 24839370.
- ↑ Kanegae MP, Ximenes VF, Falcão RP, Colturato VA, de Mattos ER, Brunetti IL; et al. (2007). "Chemiluminescent determination of leukocyte alkaline phosphatase: an advantageous alternative to the cytochemical assay". J Clin Lab Anal. 21 (2): 91–6. doi:10.1002/jcla.20140. PMID 17385676.
- ↑ Jabbour E, Kantarjian H (2014). "Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management". Am J Hematol. 89 (5): 547–56. doi:10.1002/ajh.23691. PMID 24729196.