d. Acute Promyelocytic Leukemia. In this form of leukemia, the predominant
cell in the bone marrow and blood is the promyelocyte. Often, the nucleus of this cell is
more immature than usual and the cytoplasmic granules may be large and abnormal-
e. Chronic Myelogenous Leukemia. The white count is usually 100,000 to
300,000 per cu nm at the time of diagnosis. Less than 10 percent myeloblasts are
present in the peripheral blood and there are numerous immature granulocytes.
Eosinophils and basophils are commonly increased, and the percentage of monocytes
may also show an increase. Mild normochromic anemia is generally present. The
platelet count is often increased and large forms of the platelets may be present.
f. Acute Monocytic Leukemia of Schilling. The white cell count is usually
moderately elevated with a predominant number of immature monocytes present. The
nucleus is even more lacy than in typical monocytes and it may appear to be folded or
segmented. One-to-five nucleoli may appear as fading or inconspicuous. The
cytoplasm is variable in amount, generally has few to no visible granules, and may have
a serrated-shaped border. Anemia and thrombocytopenia are usually present.
g. Acute Myelomonocytic Leukemia of Naegeli. At diagnosis, the white count
usually shows moderate to marked elevation. Anemia is commonly found and
thrombocytopenia may also be present. The abnormal cell found most commonly in this
disorder has characteristics of both the myeloblast and the monocyte. The nucleus is
monocytoid with a fine chromatin pattern and appears convoluted or folded. Granules
present in the cytoplasm show characteristics of granulocytes. All stages of these cells
are present in the bone marrow and the peripheral blood. Auer rods may be present in
the blast cell.
4-18. CLINICAL SIGNS
a. A patient with leukemia may appear to be in more or less perfect health, or, at
the extreme, when the disease is well advanced, the picture of long-drawn, progressive
ill health is noticeable; emaciation is usually apparent and pallor is well marked.
b. The major symptoms of leukemia are fever, weight loss, and increased
sweating. Enlargement of the liver, spleen, and lymph nodes may occur. The basal
metabolic rate is often elevated, and there may be hemorrhagic tendencies if marked
thrombocytopenia is present. When splenic enlargement exists, the contrast between
protuberant abdomen and the general evidences of weight loss produces a striking and