Blasts (leukaemic blast cells)
Immature blood cells that should mature in the marrow but in acute leukaemia multiply without growing up. The percentage of blasts in the marrow defines the disease: 20% or more is acute leukaemia.
Normal marrow has under 5% blasts; MDS with excess blasts has 5-19%; AML or ALL is diagnosed at ≥20% (or with defining genetic lesions at lower counts under WHO 2022/ICC). Blasts crowd out normal blood production, causing anaemia, infection and bleeding, and very high counts (hyperleukocytosis) can clog vessels. Remission is defined as under 5% marrow blasts with recovered counts, though flow cytometry and molecular MRD now detect disease far below that. In CML, progression from chronic phase to blast crisis (≥20% blasts) transforms a controllable disease into an acute leukaemia.
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