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*Elevation of [[lactate dehydrogenase]] (LDH)
*Elevation of [[lactate dehydrogenase]] (LDH)
*Elevation of [[vitamin B12]]
*Elevation of [[vitamin B12]]
===== '''Blood tests:''' =====
*[[Anemia]]
*[[Leukocytosis]] (median of 100,000/µL) with a [[left shift]]
*[[Thrombocytosis]]
*[[Blast|Blasts]] usually number <2%
*Absolute [[basophilia]] is nearly universal
*Absolute [[eosinophilia]]
*[[Monocytosis]]
*[[Thrombocytosis]]
*[[Thrombocytopenia]] suggests an alternative diagnosis or the presence of advanced stage
*Elevated [[uric acid]]
*Elevated [[histamine]] levels due to [[basophilia]]
==== '''Differential blood test:''' ====
* A differential (diff), which is a count of the different types of white blood cells in a peripheral blood sample.
==='''Peripheral  blood smear:'''===
*Increase in immature myeloid cells at various stage of maturation (i.e. myelocytes and band cells).
===== Bone marrow test: =====
*Increase in immature myeloid cells at various stage of maturation (i.e. myelocytes and band cells).
*Presence of translocation between chromosomes 9 and 22.
*Presence of BCR-ABL transcripts by RT-PCR.
==== Blood chemistry tests: ====
*Increased creatinine in some cases.
*Increased liver enzymes in some cases.
==== Conventional cytogenetics and karyotyping: ====
* This test looks at chromosomes under a microscope.
* The chromosomes can best be seen when the cell is dividing, so a sample of [[blood]] or [[bone marrow]] must be grown ''in vitro'' so that the cells start to divide.
* The leukemia cells in all [[CML]] patients contain an abnormal [[chromosome]] called the [[Philadelphia (Ph) chromosome]], which looks like a shortened version of chromosome 22.
==== Fluorescent in situ hybridization (FISH): ====
* FISH is another way to look at chromosomes and is more precise than conventional cytogenetics because it uses fluorescent dyes that only attach to specific genes or parts of [[chromosomes]].
* In [[CML]], FISH can be used to look for specific pieces of the BCR-ABL [[gene]] on chromosomes.
==== Polymerase chain reaction (PCR): ====
* This is a highly sensitive test that can be used to look for the BCR-ABL product in [[leukemia]] cells. PCR is useful for quantitation.
* It can be done on blood or bone marrow samples and can detect very small amounts of BCR-ABL, even when Philadelphia chromosome can not be detected with cytogenetic testing.
* It can be used after treatment to see if copies of the BCR-ABL gene are still present.
* If copies of this gene are found it means that the [[leukemia]] is still present.
<gallery widths="200px" class="center">
Leukemia-flurescent.jpg| A photomicrograph of leukemia cells using Direct Fluorescent Antibody staining technique (DFA).<ref name="cdc">Center for Disease Control and Prevention. Public Health Image Library 2015.http://phil.cdc.gov/phil/details.asp</ref>
</gallery>


==References==
==References==

Revision as of 15:15, 1 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]

Overview

Laboratory findings consistent with the diagnosis of chronic neutrophilic leukemia (CNL) include chronic neutrophilia. Mild anemia, thrombocytopenia, elevation of lactate dehydrogenase and vitamin B12.

Laboratory Findings

A chronic elevated concentration of blood mature neutrophils is diagnostic for CNL.[1]

Some patients with CNL may have:[2][1][3]

Blood tests:

Differential blood test:

  • A differential (diff), which is a count of the different types of white blood cells in a peripheral blood sample.

Peripheral blood smear:

  • Increase in immature myeloid cells at various stage of maturation (i.e. myelocytes and band cells).
Bone marrow test:
  • Increase in immature myeloid cells at various stage of maturation (i.e. myelocytes and band cells).
  • Presence of translocation between chromosomes 9 and 22.
  • Presence of BCR-ABL transcripts by RT-PCR.

Blood chemistry tests:

  • Increased creatinine in some cases.
  • Increased liver enzymes in some cases.

Conventional cytogenetics and karyotyping:

  • This test looks at chromosomes under a microscope.
  • The chromosomes can best be seen when the cell is dividing, so a sample of blood or bone marrow must be grown in vitro so that the cells start to divide.
  • The leukemia cells in all CML patients contain an abnormal chromosome called the Philadelphia (Ph) chromosome, which looks like a shortened version of chromosome 22.

Fluorescent in situ hybridization (FISH):

  • FISH is another way to look at chromosomes and is more precise than conventional cytogenetics because it uses fluorescent dyes that only attach to specific genes or parts of chromosomes.
  • In CML, FISH can be used to look for specific pieces of the BCR-ABL gene on chromosomes.

Polymerase chain reaction (PCR):

  • This is a highly sensitive test that can be used to look for the BCR-ABL product in leukemia cells. PCR is useful for quantitation.
  • It can be done on blood or bone marrow samples and can detect very small amounts of BCR-ABL, even when Philadelphia chromosome can not be detected with cytogenetic testing.
  • It can be used after treatment to see if copies of the BCR-ABL gene are still present.
  • If copies of this gene are found it means that the leukemia is still present.

References

  1. 1.0 1.1 Elliott, M A; Hanson, C A; Dewald, G W; Smoley, S A; Lasho, T L; Tefferi, A (2004). "WHO-defined chronic neutrophilic leukemia: a long-term analysis of 12 cases and a critical review of the literature". Leukemia. 19 (2): 313–317. doi:10.1038/sj.leu.2403562. ISSN 0887-6924.
  2. Hasle, Henrik; Olesen, Gitte; Kerndrup, GITTE; Philip, Preben; Jacobsen, Niels (1996). "Chronic neutrophil leukaemia in adolescence and young adulthood". British Journal of Haematology. 94 (4): 628–630. doi:10.1046/j.1365-2141.1996.7082329.x. ISSN 0007-1048.
  3. Elliott, Michelle A. (2006). "Chronic neutrophilic leukemia and chronic myelomonocytic leukemia: WHO defined". Best Practice & Research Clinical Haematology. 19 (3): 571–593. doi:10.1016/j.beha.2005.07.012. ISSN 1521-6926.
  4. Center for Disease Control and Prevention. Public Health Image Library 2015.http://phil.cdc.gov/phil/details.asp

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