PERIPHERAL SMEAR FINDINGS IN ACUTE AND CHRONIC LEUKEMIA.

ACUTE MYELOGENOUS LEUKEMIA:
RBC: Normocytic normochromic type of anemia
WBC: Multiple myeloblasts ( more than 20%) will be seen. Myeloblasts may contain several fine rods-like structures called Auer rods. These are seen only in acute leukemias of myeloid differentiation.
PLATELETS: Moderate to severe thrombocytopenia can be seen.

To Know the difference between Myeloblast and Lymphoblast CLICK HERE

ACUTE LYMPHOBLASTIC LEUKEMIA:
RBC: Normocytic normochromic type of anemia
WBC: Increased counts with mre than 20% lymphoblasts will be seen. Lymphoblasts are larger cells with high N:C ratio with condensed chromation and absent to inconspicuous nucleoli.
PLATELETS: Thrombocytopenia

Morphologically there are three subtypes of ALL (FAB Classification)
ALL-L1: Small uniform cells. Nuclei regular with condensed chromatin, inconspicuous nucleoli. Scant cytoplasm
ALL-L2: Large, heterogenous cell population. Nuclei irregular/clefting with occasional nucleoli. Mild to moderate cytoplasm
ALL-L3: Large, homogeneous cell population. Nuclei regular with fine chromatin and 1-2 nucleoli.Moderate to abundant vacuolated cytoplasm

CHRONIC MYELOGENOUS LEUKEMIA
RBC: normocytic normochromic type of anemia
WBC:Leukocytosis with left shift with immature granulocytes( including bands, metamyelocytes, myelocytes, and promyelocytes ) as well as absolute eosinophilia and basophilia.
Circulating blasts may also be seen in chronic phase CML but are usually few (<5%).
PLATELETS: platelet count is normal or moderately increased.

CHRONIC LYMPHOCYTIC LEUKEMIA
RBC: normocytic normochromic type of anemia
WBC: The neoplastic lymphocytes are small(slightly larger than normal small lymphocytes) and show scant cytoplasm and round to irregular nuclei containing clumped chromatin.Nucleoli are small to indistinct. A distinct feature is the presence of “smudge” or “basket” cells which are the neoplastic cells that got “smudged” during slide preparation as these cells are fragile in nature.
PLATELETS: Normal to decreased