Diagnosis of hemoblastosis

Diagnosis of hemoblastosis can be difficult with scanty punctate bone marrow. This can be observed in aplastic conditions, myelofibrosis, MDS with fibrosis or tumor metastases. In cases where a proliferative pathological clone has been identified (myeloblasts, megakaryoblasts), acute leukemia with myelofibrosis is diagnosed, otherwise acute or chronic idiopathic myelofibrosis is diagnosed. In acute panmielosis, in contrast to chronic idiopathic myelofibrosis, young forms of myelopoiesis, including mononuclear megakaryocytes, predominate in the bone marrow.

Acute leukemias also have to be differentiated from blast crises in the inventories and, in particular, CML. Special difficulties are presented when the CML manifests with a blast crisis. The presence of the Ph-chromosome in most cases helps to establish the diagnosis of CML. It should be noted that the Philadelphia chromosome is also detected in rare cases of myeloblastic and in 25% lymphoblastic leukemia, which makes diagnosis difficult. Imperious crises of CML can be myeloid and lymphoid, and differential diagnosis is carried out with the appropriate variant of acute leukemia. The picture of the bone marrow in the myeloid blast crisis of CML is much more variegated than in ONLL: eosinophils, basophils may be present in the granulocyte sprout, pathological microforms of megakaryocytes are found.

Cells in the blast population are more diverse in their morphoimmunological features compared with acute leukemia, myeloblasts, erythroblasts, megakaryoblasts can be detected at the same time, and lymphoblasts in some cases. The picture of lymphoid blast crisis is more monomorphic and similar to that in ALL. Ph-positive clone in CML and ALL is different in its functional features, which is associated with the structural features of BCR / ABL oncogenes in these two hemoblastosis. In ALL, the BCR / ABL gene encodes the abnormal p190 protein, and in CML, the p210 protein is produced. With the help of molecular research methods (PCR reaction) establish an accurate diagnosis.

Certain diagnostic difficulties may also occur in the differential diagnosis of ONLL and metastases of alveolar rhabdomyosarcoma and neuroblastoma in children.