Leukemia comprises a diverse group of clonal hematopoietic malignancies characterized by abnormal proliferation of white blood cells in the bone marrow and peripheral circulation. These disorders are broadly classified into acute and chronic leukemias, each with distinct clinical behavior, prognosis, and management strategies.

Early and accurate diagnosis is critical, as many leukemias—particularly acute leukemias—require urgent intervention. While modern diagnostic modalities such as flow cytometry, cytogenetics, and molecular studies have significantly improved classification and prognostication, they may not always be immediately available, particularly in resource-constrained settings.

In such scenarios, peripheral blood smear examination serves as the first and often most informative diagnostic tool. It provides immediate morphological details, including identification of blasts, assessment of cell lineage, and detection of characteristic features such as Auer rods, smudge cells, and basophilia.

Moreover, PBS allows correlation with clinical findings and can guide further investigations. Its role is especially crucial in initial suspicion, triaging patients, and initiating early management.

The present study was undertaken to evaluate the diagnostic utility of peripheral blood smear in various leukemias and to correlate morphological findings with clinical and demographic parameters.

MATERIALS AND METHODS

This retrospective observational study was conducted on 55 cases of leukemia. Study Design we chose is of retrospective descriptive study.Study Setting conducted in a tertiary care center, P.D.U. Government Hospital, Rajkot. Study Duration was from 1^st August 2025 to 31^st March 2026.

Data Collection

The following parameters were recorded:

• Age and gender
• Clinical presentation
• Hematological parameters
• Peripheral smear findings

Peripheral Smear Examination

• Blood samples collected in EDTA vials
• Smears prepared using standard
• Stained with Leishman stain and Field Stain.
• Examined under light microscopy.

RESULTS

A total of 55 cases were analyzed.

Table 1: Distribution of Leukemia Types

The most common leukemia observed was AML (30.91%), followed by CML (20%). Acute leukemias constituted a larger proportion compared to chronic leukemias, indicating a higher burden of aggressive disease presentation.

Table 2: Gender Distribution Of various Leukemia

There was a clear male predominance (60%) compared to females (40%). This trend was consistent across most leukemia subtypes, suggesting possible gender-related susceptibility or healthcare access differences.

Table 3: Age Distribution Of various Leukemia

ALL was predominantly seen in children (<10 years). AML showed a wider age distribution. CML was more frequent in young to middle-aged adults. CLL was mainly observed in older age groups. This reflects known epidemiological patterns of leukemia distribution.

Table 4: Clinical Presentation

Pallor (34.5%) was the most common presenting feature, reflecting underlying anemia. Lymphadenopathy and splenomegaly were also frequent findings, particularly in CLL and CML respectively. Bleeding manifestations were less common but clinically significant.

Table 5: CML cases distribution according to Phases

Majority of CML cases (80%) were diagnosed in the chronic phase, indicating early detection in most patients. However, presence of blast crisis cases highlights delayed presentation in a subset.

Table 6: AML Subclassification

AML M2 was the most common subtype, followed by AML M0. Presence of APML cases is clinically significant due to its distinct treatment and prognosis.

Table 7: Peripheral Smear Findings

Blasts were the most frequent finding (23 cases), confirming their central role in diagnosing acute leukemias. Smudge cells were characteristic of CLL, while basophilia was strongly associated with CML. Auer rods, though less frequent, provided definitive evidence of myeloid lineage.

Image:1: Acute lymphoblastic leukemia: Blasts having high N:C ratio. 1-2 inconspicous nucleoli are seen. (Field stain,40x)

Image:2: Acute promyelocytic leukemia. Many promyeolocytes with auer rods are seen. Fggot cells are also seen. (Field stain,100x)

Image:3: Acute myelomonocytic leukemia. Many monoblasta having reniform nuclei and cytoplasmic vacuolation are see. Myeloblasta are also present. (Field stain,100x)

Image:4: Chronic myeloid leukemia. Myelomonocytic buldge is seen. (Field stain,100x)

Image:5: Chronic lymphocytic leukemia. Many mature lymphocytes are seen. (Field stain,40x)

DISCUSSION

The present study reinforces the critical role of peripheral blood smear in the initial diagnosis of leukemias.

The predominance of AML observed in this study aligns with multiple regional studies, where AML is frequently reported as the most common adult leukemia. The relatively high proportion of acute leukemias emphasizes the need for rapid diagnostic methods, as delays can significantly impact patient outcomes.

Male predominance noted in this study has been consistently reported in hematological malignancies. While the exact reason remains unclear, genetic, environmental, and occupational factors may contribute.

The age distribution findings were also in agreement with established patterns. ALL showed a clear predilection for pediatric age groups, whereas CLL was predominantly seen in elderly individuals. CML affected a relatively younger population in this study compared to Western data, which is a known trend in developing countries.

Clinical presentation in leukemia is often nonspecific. Pallor being the most common symptom reflects anemia due to marrow infiltration. Lymphadenopathy and splenomegaly are important clinical clues that help narrow the differential diagnosis.

Peripheral smear findings played a decisive role in diagnosis. Blasts enabled identification of acute leukemias. Auer rods confirmed myeloid origin.Smudge cells were highly suggestive of CLL.Basophilia strongly pointed toward CML.

These morphological features not only aid in diagnosis but also help prioritize further confirmatory tests such as bone marrow examination and immunophenotyping.

In resource-limited settings, where advanced diagnostics may be delayed, PBS serves as an invaluable frontline tool. It enables early clinical decision-making and initiation of supportive therapy.

CONCLUSION

Peripheral blood smear examination continues to be an indispensable diagnostic modality in hematology.It is rapid, cost-effective, and widely accessible.Provides crucial morphological insights.It enables early diagnosis and classification of leukemias. Guides further diagnostic and therapeutic interventions

Even in the era of advanced technologies, PBS remains a cornerstone in the initial evaluation of leukemia.

REFERENCES

1. Bain BJ. Blood Cells: A Practical Guide.
2. Hoffbrand AV, Moss PAH. Essential Haematology.
3. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues.
4. Greer JP. Wintrobe’s Clinical Hematology.
5. Dacie JV, Lewis SM. Practical Haematology.
6. Tefferi A. Primary leukemias: clinical review.
7. Lichtman MA. Leukemia overview and classification.
8. Swerdlow SH. WHO hematologic malignancy classification updates.
9. Arber DA et al. AML classification and diagnosis guidelines.
10. Hallek M. Chronic lymphocytic leukemia: diagnosis and treatment.