How do you differentiate between acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) based on peripheral smear and bone marrow findings?
Differentiating Acute Lymphoblastic Leukaemia (ALL) from Acute Myeloid Leukaemia (AML) is essential for prognosis and treatment. Diagnosis relies on peripheral smear, bone marrow findings, and cytochemistry.
Blasts: In ALL, blasts are predominantly lymphoblasts (>20% of non-erythroid cells), small, homogeneous, with scant basophilic cytoplasm, round or oval nuclei, finely dispersed chromatin, and usually absent or small nucleoli. In AML, blasts are myeloblasts (>20%), larger and heterogeneous, with abundant cytoplasm, fine azurophilic granules, and round, oval, or kidney-shaped nuclei with prominent nucleoli.
Auer Rods: Absent in ALL; present in ~50–60% of AML cases.
Cytochemistry: Myeloperoxidase (MPO) and Sudan Black B (SBB) are negative in ALL and positive in AML. PAS staining is block-like in ALL, diffuse fine granular in AML. Non-specific esterase is typically negative in ALL but positive in monocytic AML.
Thus, ALL features immature lymphoid blasts, while AML shows myeloid blasts, with Auer rods or MPO/SBB positivity confirming AML.
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