[Music] welcome people in this video we will look at this case study a 45 year old man presented with fever acute onset suddenly he got some fever he has fatigue bone pain and gum bleeding own failed gum bleeding on external examinations thermal tenderness was present he's what let us look at the laboratory findings probably can give us some clue hemoglobin so less so definitely to some anemic picture ee see a WBC count is more right so looks like some infliction infection platelet count is fifty thousand very less very less very less so what is your diagnosis case there is some peripheral blood smear given here in peripheral blood smear what you can see so remember this is blood picture in blood picture they are showing some body in the cytoplasm the nucleus what exactly are these there's some rods here our rods these are our rods okay let's see so here are the diagnosis when you see all rods and they're giving you such a clear picture right so definitely it will be AML that is acute myeloid leukemia you know in chronic I'll my lord look may there be no our rods remember so this is acute myeloid leukemia and you can see that in the bone marrow sorry in the blood picture there are some cells like this right these are not supposed to be here a first account in the blood so in blood picture you're seeing some myeloblast with all rods so in CML remember there'll be no all rods in myeloblast but here you're seeing all rods right so definitely AML you can say there is an anemic blood picture the WBC's are very high platelets are less and fevers it is just a clue here fevers are cute onset I'm not sure so what is the diagnosis acute myeloid leukemia right two points in favor you have written that how do you classify this condition oh my god this is a huge thing we will explain that wait there's how to classify basically there are two classifications okay waho classification and fvb classification okay before going to classification look at this the fever is a feudin onset we told you here gum height hypertrophy is there that's my gum bleeding advance third a little tenderness this is like at the biggest clue you can get for this okay now coming to the classification right let's make a new slide for this because it's already fully AML there is whu-oh classification and FA B classification two types of classifications are there now WH o means you know the World Health Organization classification and what does this if every French American British straight now according to WH o classification you have so many up you'd myeloid leukemias okay with genetic abnormality you have with genetic abnormality let's just pay attention here there can be many types of genetic abnormality okay like translocation 821 inverted sixteen transfer gate in 1517 so many other the textbook just look at them okay we are not going into the details so many types of classification are there then you have acute myeloid leukemia with myelodysplasia are related changes then you have therapy related the ml so I think they gave some therapy and they got acute myeloid leukemia is it God knows then you have not otherwise classified this is actually nothing but fib classification guys this is nothing but a favori classification so we conveniently put it here we'll conveniently put it here okay nothing but a heavy classification that is m0 m1 m2 m4 m5 m4 m5 am Phi B there is no three here remember but in five there are two then six and seven okay then in that only you have a cute basophilic leukemia myeloid sarcoma mylord proliferations due to Down syndrome okay so much of classification is there at least a Febby classification you try to remember now this 1 2 3 4 & 6 1 2 3 4 & 6 these are milo peroxidase positive okay 1 2 hold on six are myeloperoxidase positive what are they first of all that we should tell no m0 is minimally differentiated this is without maturation m1 is without maturation AML with maturation is m2 m4 is Milo monocyte o'clock a Mia then five and five and five we are mono blastic monocyte o'clock a mia m6 azerath roid leukemia m7 is mega carry or blastic leukemia see basically one thing you should understand here what exactly is happening here the myeloid leukemia acute myeloid leukemia means something to do with the myeloid progenitor correct now myeloid progeny to water and all it will give it will give RBC it will give WBC's except lymphocytes and then it will give platelets correct so other than lymphocytes everything you should have here correct so now see this m6 is what edit roid then you what you have base so Omega carrier this is mega carrier mega cario blastic then what in all you have mono blastic mono cyclic that is this one no plastic mono cyclic this one in 5mm 5a 5b that is acute mono plastic and monocyte a clippie mia first turn on water and all this is called a ml minimally differentiated ml minimally differentiated a male without maturation he ml with maturation is m2 m4 is what acute Milo monocyte o'clock a Mia what the hell you - Milo mono-cyclic tuk Mia this is purely hard not to understand so many complicated terms okay guys to whatever extent possible we have explained hopefully you have understood the classification of this see basically here what you're seeing your ingor myeloid progeny myeloid seedy cells you're not seeing any lymphocytes that's what you have to pay attention to that's all otherwise it's easy so you can see so many basophils when you see them so many basophils a look at acute basophilic leukemia then what you can have acute erythroid leukemia then acute megakaryocytes possible so many things are possible okay no classification over then what are the specific Saito chemical stains this is also important so the specific Saito chemical stains are shall we write them here only is it that okay for you specific Saito chemical stains with specific site or chemical stains leather Saito chemistry that you will use for detecting AML what in all you'll use you will use Milo per oxidase we already told you what it all are positive right go here and check again 1 2 4 & 6 are positive M 2 4 & 6 M 1 2 4 1 2 4 & 6 are positive correct 1 2 4 & 6 are positive now myeloperoxidase it is positive in immature myeloid cells containing granules and/or rods they are negative in the M 0 myeloblast okay so what it all will be there they are myeloid will be positive in there this Milo Milo peroxidase stain if you use it is positive in my load cells which contain granules and or rods obviously or rods is absent in CML obviously myeloperoxidase also will be negative in that in this case you can see that because of granules and oil rods this is showing positive myeloperoxidase okay then Subban black the next stain that we have to talk about this su van black sedan black is the next let's take this up also in a new slide because now my low peroxidase you saw now we will see sudan black sedan black is positive in immature cells in the ml so it is positive in immature cells in a ml don't sleep don't sleep wake up if you're sleeping we are looking at what the stains site no chemistry for AML sudan black then periodic shift acid shift pass buses periodic acid is c hif shift this is also positive in immature lymphoid cells and eric throw leukemia but here immature lymphoid cells will not be that in blood picture right for it to be a very minor amount then nonspecific esterase nonce specific yesterday's positive and monocyte exceeding so in m4 and m5 that is in monocyte exceed ease it will be there positive in mono-cyclic series have you seen the monocyte of series guys which are the mono-cyclic series m4 is mono-cyclic myeloma no sciatic an m5 also his mono sighting so in this m4 and m5 what will be positive that non specific s stress will be positive did you understand any word you've already seen the classification so this should be easy to see then last one you have acid phosphatase acid phosphatase is going to be focal positivity in leukemic blast in all yelling and diffuse reaction in monocyte excels so there will be some positivity in m4 and m5 again and in ll that is a cure look lymphoid leukemia it will be there positive okay so I ll and in m4 and m5 see here don't write in Rome get confusing for us also seen in Yellin okay so this periodic shift for acid ship is a positive in immature lymphoid cells and Edith Crawley UK Mia lives in m6 name in six it is positive positive in m6 and m6 is what edit rhodius that's why it is positive in lymphoid and erythro leukemia so in m6 okay and even in lymphoid he mature lymphoid also okay this is erythroid area through leukemia okay did you understand this much guys so basically what you should understand here EML is a condition where the myeloid series cells will be more so whatever staining you are doing again is reflecting the myeloid series cells only like acid phosphatase and this nonspecific x-rays they seem to like these monocytes okay lymphoid progenitor also acid phosphatase can stain and here immature lymphoid even pass Suda and black all immature cells in AML positive and immature cells in AML myeloperoxidase very important one two four and six 1/2 cup four four two four six one two car for four to six hope it's some song is there then that's all over so we are done with this case study guys so this was a case study on acute myeloid leukemia that's all for now do you know what these cells are by the way these are milo blasts Milo plus these are precursors of neutrophil forming girls right myeloblast means what neutrophils only they'll become right later actually they can become neutrophil less no fill base of fill and monocyte all these four they can become myeloblast means that's all guys sweet dreams bye bye [Music]