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I myself don't know how to read a smear. Usmle doesn't want you know that much.

One thing they surely want u to know about it.

Their is a very high while blood cell count; but that much a high count also occurs in leukemias. So how would you differentiate between two. Usmle wants to know what laboratory value u would send?

Well alkaline phosphatase. in leukemoid reaction, cells are normal; so would have high alkaline phosphatase value. in leukemas cells are abnormal, don't express alkaline phos; so would have low values.
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