Differential diagnosis of acute leukemia

Differential diagnosis of acute leukemia is carried out with other diseases of the hematopoietic system (non-Hodgkin’s lymphomas, myelodysplastic syndromes, blast crisis of chronic myeloid leukemia, multiple myeloma, aplastic or megaloblastic anemia), leukemoid reactions (most often associated with lymphoma cytosarcidoproteinoproteinoproteinoproteinoproteinoprostocrostostostostosidocaptophaloprooptosinopoproteinza anemia, anesthesia-anemia-anemia-anemia-anemia-anaineathrotostostostosidrotherapy syndrome, blast crisis, chronic myeloid leukemia, blast crisis). pronounced monocytosis in tuberculosis and other infectious diseases), “exit” from agranulocytosis, metastasis of solid tumors in the bone marrow.

The study of the bone marrow almost always allows to exclude non-hematological pathology, since in acute leukemia there is an increase in the content of blast cells. Detection of at least 20% of typical blast cells in a smear of peripheral blood and / or bone marrow eliminates most hematological diseases that have similar clinical and laboratory manifestations.

The exceptions are:

1) one of the variants of myelodysplastic syndrome (MDS) (refractory anemia with an excess of blasts – RAIB), which usually differs from acute leukemia only by the percentage of blast cells in the bone marrow;

2) blast crisis of chronic myeloblastic leukemia.

In 30% of patients over 60, the development of acute myeloblastic leukemia is preceded by one of the variants of myelodysplastic syndrome (MDS) (most often RIBS). In both cases, the results of treatment and the prognosis are usually unfavorable, therefore the differences between refractory anemia with an excess of blasts (RAIB) and secondary acute myeloblastic leukemia (AML) developed from myelodysplastic syndrome (MDS) do not have significant clinical significance.

For differential diagnosis with blast crisis of chronic myeloblastic leukemia (CML), it is necessary to consider the history of the disease, clinical data, the results of cytogenetic research and immunophenotyping. When formulating a diagnosis, it is necessary to isolate secondary acute leukemias (almost always acute myeloblastic leukemias (AML)) that developed after radiotherapy and / or chemotherapy for tumor and non-tumor diseases.