Chronic neutrophilic leukemia laboratory findings

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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.

Some patients with CNL may have:

• Mild anemia
• Thrombocytopenia
• Elevation of lactate dehydrogenase (LDH)
• Elevation of vitamin B12

Blood tests:

• Peripheral blood White blood cells (WBC) ≥25 ×10⁹/L
• Segmented neutrophils plus band forms ≥80% of WBC
• Myeloblasts rarely observed
• Monocyte count <1 ×10⁹/L
• No dysgranulopoies.
• Leukocytosis (median of 100,000/µL) with a left shift
• Thrombocytosis
• 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.