Acute Erythroblastic leukemia (M6)

 

Erythroleukemia is a rare form of acute myeloid leukemia (AML) where the myeloproliferation is of erythrocyte precursors. M6 or erythroleukemia is rare and difficult to diagnose. More than 30-50% of the nucleated marrow cells are abnormal nucleated red blood cells. Erythroleukaemia  myeloid blasts express a variety of myeloid markers, similar to othe subtypes of AML ­ CD13, CD33, CD117 (ckit) and MPO. The erythroblasts lack myeloid antigens but are positive to glycophorin A.

In Pure erythroid leukaemia: Erythroid blasts which have differentiated will be positive with glycophorin A but negative with MPO and myeloid markers. The more immature blasts are difficult to identify as erythroid because they are usually negative for glycophorin A. Immature erythroid progenitors may be detected using carbonic anhydrase 1 or CD36. Although CD36 is not specific for erythroid progenitors, negative markers for megakaryocytes and monocytes will aid the diagnosis. Chromosome Abnormalities are  8+, -5, del(5q), and -7.   

The prognosis of acute erythroid leukaemia is reported as poor. It is, however, important to differentiate de novo from secondary or therapy related erythroid leukaemia, where the later have a worse prognosis.

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Above case shows (lymp-green, grans-blue, ERYTHROBLAST-red, Monocytes-pink) positivity for CD71, CD235a, CD36, CD11b and negativity for MPO, CD34, CD19, CD117, CD13,  cCD79a, cCD3

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