Cml slide n label
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Here is the complete labeled breakdown of the CML peripheral blood smear:
CML - Peripheral Blood Smear
Slide 1 (Robbins Basic Pathology)
Slide 2 (Robbins & Cotran Pathologic Basis of Disease)
What to Label on the CML Smear
Cells Present (Left Shift - All Stages of Myeloid Maturation)
| Cell | Key Features to Label |
|---|---|
| Mature neutrophils (segmented) | Multi-lobed (2-5 lobes) dark purple nucleus, pink granular cytoplasm - most numerous cell |
| Band neutrophils | U-shaped or horseshoe nucleus, no segmentation |
| Metamyelocytes | Kidney/indented nucleus, pale pink cytoplasm with granules |
| Myelocytes | Round to oval nucleus (no indentation), abundant cytoplasm with primary + secondary granules |
| Promyelocytes | Large cell, round nucleus with prominent nucleolus, prominent azurophilic (purple) primary granules |
| Basophils | Dark purple-black coarse granules that may obscure the nucleus - characteristically increased in CML |
| Eosinophils | Bi-lobed nucleus, large bright orange-red granules - also increased |
| Platelets | Numerous small anucleate fragments - often markedly elevated (thrombocytosis) |
| Red blood cells | Normal-appearing biconcave discs in background |
Key Diagnostic Features to Note
- WBC markedly elevated - often >100,000 cells/µL
- Full myeloid spectrum in peripheral blood (normally only mature neutrophils and bands are seen)
- Basophilia - characteristic and distinguishes CML from leukemoid reaction
- Eosinophilia - also present
- Thrombocytosis - platelets often increased
- Low LAP (Leukocyte Alkaline Phosphatase) score - distinguishes from leukemoid reaction where LAP is high
Pathogenesis Diagram
The t(9;22) Philadelphia chromosome translocation creates the BCR::ABL fusion gene → 210 kDa BCR-ABL fusion protein → constitutive kinase activity → activates RAS, STAT, AKT → growth factor-independent proliferation with preserved differentiation (hence the mature cells in blood).
CML vs Leukemoid Reaction (Quick Differentiator)
| Feature | CML | Leukemoid Reaction |
|---|---|---|
| LAP score | Low | High |
| Basophils | Increased | Normal |
| BCR-ABL | Positive | Negative |
| Cause | Neoplastic | Reactive (infection, stress) |
- Robbins & Cotran Pathologic Basis of Disease, p. 583-584
- Robbins Basic Pathology, p. 583
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