Leukemia Stains

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Leukemia Stains


Leukemia stains are laboratory tests done on bone marrow or blood samples to help diagnose specific types of leukemia.


Leukemia stains are done to diagnose and classify leukemia. Blood contains red cells, several varieties of white cells, and platelets. Cancerous overproduction of any one type of cell produces one of many types of leukemia. A patient's specific type of leukemia must be classified in order to provide the best treatment and most accurate prognosis.

The type and maturity of the cells involved are identified by analyzing blood and bone marrow under a microscope. Often, however, the abnormality or immaturity of the cells make it difficult to identify the cell types with certainty. Special leukemia stains help to distinguish one cell type from another.


Special stains are added to bone marrow or blood that has been smeared on a microscope slide. Cell types react differently to the chemicals in the stains.

If the patient has few white cells, a buffy coat smear is made. A tube of blood is spun in a centrifuge. Red cells fall, plasma rises, and white cells settle in a thin middle layer called the buffy coat. The smear is made from this layer.

Sudan black B stain

This stain distinguishes between acute lymphoblastic leukemia (cells stain positive) and acute myeloblastic leukemia (cells stain negative).

Periodic acid-Schiff stain (PAS)

The PAS stain is primarily used to identify erythroleukemia, a leukemia of immature red blood cells. These cells stain a bright fuchsia.

Terminal deoxynucleotidyl transferase stain (TdT)

The TdT stain differentiates between acute lymphoblastic leukemia (cells stain positive) and acute myelogenous leukemia (cells stain negative).

Leukocyte alkaline phosphatase (LAP)

The LAP stain is used to determine if an increase of cells is due to chronic myelogenous leukemia or a noncancerous reaction to an infection or similar conditions. Cells from a noncancerous reaction stain positive with many intense blue granules; cells from chronic myelogenous leukemia have few blue granules.

Tartrate-resistant acid phosphatase stain (TRAP)

The TRAP stain is primarily used to identify hairy cell leukemia cells. These cells stain with purple to dark red granules.

Myeloperoxidase stain

The myeloperoxidase stain distinguishes between the immature cells in acute myeloblastic leukemia (cells stain positive) and those in acute lymphoblastic leukemia (cells stain negative).

Leukocyte specific esterase

This stain identifies granulocytes, which show red granules.

Leukocyte nonspecific esterase

Nonspecific esterase stain identifies monocytes and immature platelets (megakaryocytes), which show positive black granules.


Leukemia stains are done on smears of blood or bone marrow. To collect blood, a healthcare worker draws blood from a vein in the inner elbow region. Collection of the sample takes only a few minutes.

When bone marrow is needed, the person is given local anesthesia. Then the physician inserts a needle through the skin and into the bone-usually the breast bone or hip bone-and 0.5-2 mL of bone marrow is withdrawn. This procedure takes approximately 30 minutes.


Patients sometimes feel discomfort or bruising at the puncture site after blood collection. They may also become dizzy or faint. Pressure to the puncture site until the bleeding stops reduces bruising. Warm packs to the puncture site relieve discomfort.

Collection of bone marrow is done under a physician's supervision. The patient is asked to rest after the procedure and is watched for weakness and signs of bleeding.

Normal results

A normal blood or bone marrow smear shows no evidence of leukemic cells. The expected reaction of cells varies with the type of stain.

Abnormal results

Leukemia stain results that help diagnosis and classify leukemia are supported by the results of other laboratory tests and the person's clinical condition.



Fischbach, Francis. Manual of Laboratory and Diagnostic Tests. Philadelphia: Lippincott, 1996.


Bone marrow The spongy tissue inside large bones where blood cells are formed.

Buffy coat The thin layer of concentrated white blood cells that forms when a tube of blood is spun in a centrifuge.

Leukemia Any of several cancers of the bone marrow characterized by the abnormal increase of a type of blood cell.

Leukemia stains Special stains added to smears of blood or bone marrow, performed to diagnose and classify leukemia.