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Leukocyte Alkaline Phosphatase Scoring

View larger version (155K): [in this window] [in a new window]   Figure 1. The leukocyte alkaine phosphatase (LAP) score is often used in patients with an elevated WBC to differentiate a reactive process from chronic myelogenous leukemia.The score in the latter is low while it is within the normal reference range or elevated in the former condition. Naphthyl AS-B1 phosphate is hydrolyzed to phosphate and an aryl maphthylthalamide by alkalline phosphatase in the cytoplasm of WBCs. The aryl naphthylthalamide is coupled to diazonium salt (fast red violet LB) forming an insoluble blue dye within the cytolasm of the WBCs. Neutrophils and bands are scored (0 to 4+) and the total score of 100 of these cells is the LAP score. Variable intensity of blue staining can be seen in the leukocytes in this peripheral smear from a patient with a reactive leukocytosis.

View larger version (156K): [in this window] [in a new window]   Figure 2. Five neutrophils are present in this view. Beginning with the top cell and proceeding in a clock-wise fashion the individual cells would be scored as 1+,3+,1+, 2+ and 2+ for a total score in this field of 9.

View larger version (154K): [in this window] [in a new window]   Figure 3. Both of the neutrophils in this view would be scored as 2+. The pink staining of the lobes of the nucleus are still visible are are clear areas in the cytoplasm.

View larger version (161K): [in this window] [in a new window]   Figure 4. The neutrophil in this image would be scored as a 3+ with intense cytoplasmic staining but nuclear lobes still visible.

View larger version (154K): [in this window] [in a new window]   Figure 5. The top neutrophil in this image is a 3+ while the second neutrophil would be scored as a 4+ i.e. intense cytoplasmic staining with the nucleus obscured.

View larger version (160K): [in this window] [in a new window]   Figure 6. The top two neutrophils in this image are scored as 1 and 2+ respectively while the bottom neutrophil is scored as 0 (no cytoplasmic staining). Note the nucleated RBC next to the top two neutrophils does not stain.

View larger version (155K): [in this window] [in a new window]   Figure 7. This low power view of a peripheral smear is from a patient with chronic myelogenous leukemia. Note the abundant neutrophils present and the paucity of blue stain in these cells. Most of the neutrophils in this image would graded as 0.

View larger version (104K): [in this window] [in a new window]   Figure 8. In this higher powered view of the peripheral smear from the same patient, most of the neutrophils are unstained (0 score) and minimal staining in the remainder (one of the neutrophils would be scored as 2+).

View larger version (151K): [in this window] [in a new window]   Figure 9. A further illustration of the staining pattern in patients with CML is shown in this image. The neutrophil in the center is 2+, two others are 1+ and the remainder are scored as 0. Low LAP scores are not specific for chromin myelogenous leukemia but can also be seen in patients with myelodysplastic syndrome, paroxysmal nocturnal hemoglobinuria and hypophosphatasia.

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazarchick, J. Search for Related Content PubMed Articles by Lazarchick, J. Related Collections Myeloproliferative Diseases Related ASH-SAP Chapter Related Image Bank Image Sets Related ASH Education Book Articles Social Bookmarking                   What's this?