pancytopenia with circulating blasts is characteristic
WBC - normal or raised; 50% of individuals have count less than 10 x 10^9/l; 20% have count greater than 100 x 10^9 /l; usually a preponderance of blasts but 10% have aleukaemic leukaemia - blasts absent from peripheral blood although still present in marrow
red cells - anaemia - usually normocytic but may be macrocytic; progressive, may become severe
platelets - usually reduced
bone marrow - hypercellular; diagnosis is made on having more than 30% blasts in the marrow
CSF - blasts present in meningeal leukaemia
CXR - often mediastinal mass in ALL especially T cell
blood cultures - always if patient is febrile
coagulation studies - DIC indicated by reduced fibrinogen, increased prothrombin time, presence of fibrin degradation products
hyperuricaemia and hypokalaemia often seen
important to distinguish between AML and ALL:
morphological - Auer rods pathognomonic of AML
histochemical stains for myeloid enzymes such as peroxidase or chloroacetate confirm AML
surface markers characteristic of primitive lymphoid cells identify ALL, e.g. terminal deoxynucleotide transferase present in 95% of cases of ALL
primitive B lymphocyte antigens such as CALLA, B1, BA1 may help to identify ALL
T cell ALL diagnosed by rosette formation with sheep erythrocytes or identification of cell markers by monoclonal antibodies such as Leu-1 or Leu-9
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