*Leukemia

Group 3:

Differentiating between Acute and Chronic

Christopher Phipps Karlene Irwin Alwyn Coleman Tamarie Price

*
* Named after the leukocytes, white blood cells which
mutate before maturity and become cancerous.

* Leukemia is termed as a type of cancer that affects the

blood and bone marrow, the spongy center of bones where our blood cells are formed. The disease develops when blood cells produced in the bone marrow grow out of control.

* These cells reproduce rapidly, suppressing production of

normal white cells that are essential to fighting infection in the body, and red cells that are needed to carry oxygen in the blood. Cancer cells may spread to the liver, spleen, lymph nodes, genitals, or the brain.

*
* Acute leukemia is characterized by a rapid increase in the numbers
of immature blood cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children. * Chronic leukemia is characterized by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.

*
Acute Leukemia Age group Clinical onset Course (untreated) All ages Sudden Les than 6 months Chronic Leukemia Adults Insidious 2-6 years

Leukemic cells
Anemia Thrombocytopenia White blood cell count organomegaly

Immature
Mild to severe Mild to severe Variable Mild

Mature
Mild Mild Increased Prominent

* Acute Leukemia
* Usually diagnosed incidentally based on high white
blood cell counts

* Divided into two groups based on cell of origin:

Acute Lyphmhocytic Leukemia

Acute Myelogenous Leukemia

*Acute Leukemia
*Bone Marrow failure *Anemia *Thrombocytopenia *Neutropenia *DIC *Lymphadenopathy *CNS involvement

Laboratory findings of Acute Leukemia

Pancytopenia

30%

*Proliferation of blasts *Disorder originates in a

single B or T lymphocyte progenitor

Laboratory findings of Acute Leukemia

* Acute

lymphocytic Leukemia (ALL) will have granules in blast cells. A special cell marker called TdT is present in 95 percent of cases. It is subtyped to either B-cell or Tcell type.

Laboratory findings of Acute Leukemia

* Other lab findings may include disseminated intravascular

coagulation (DIC), which is a severe depletion of clotting factors in the blood.

Uric acid level may be elevated. Lumbar puncture (spinal tap) will show

*(AML) occurs froom children up

to adults and more commonly in men than women. chemotherapy.

*AML is treated with *The five-year survival rate is

40%.

Laboratory findings of Acute Leukemia

* Acute

myelogenous Leukemia (AML) shows Auer rods in the blast cells. Special stains may also be done: Sudan Black

*Acute myeloid leukemia, without maturation

*Acute myeloid leukemia, with maturation

*Subtypes of AML include acute

promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.

* Chronic Leukemia
* Usually diagnosed incidentally based on high white
blood cell counts

* Divided into two groups based on cell of origin:

Chronic Myelogenous Leukemia

Chronic Lyphmhocytic Leukemia

*Most frequently a neoplasm of

B lymphocytes

*Malignant proliferation of T
cells less common.

*
*Characterized by peripheral

blood and bone marrow lymphocytosis *Proliferation of more mature (non-blast cells) *Lymphocyte either slightly smaller/larger than the normal lymphocyte *Hypercondensed, soccer ball appearing nuclear chromatin pattern *Bare nuclei or smudge cells common

*Increased (greater than

10%) prolymphocytes

*Larger proliferative

lymphocytes have exaggerated nuclear irregularities, lobulations or nuclear folds lymphoplasmacytoid cells (mixed type)

*Increased

*Neutropenia *Anemia
*Thrombocytopenia

*General

pancytopenia due to accumulating lymphocyte mass

*(CML) occurs mainly in adults *Treatment is with imatinib

(Gleevec in US, Glivec in Europe) or other drugs. 90%.

*The five-year survival rate is *A subtype of CML is chronic

monocytic leukemia.

*Neutrophil maturationseen in CML

*Increased RBC in PV (polycythemia rubra vera)

*Teardrop RBCs in MMM (myeloid metaplasia)

*Increased Thrombocytes in ET
(Essential thrombocythemia)

*French-American & British

Classification

M 0- Acute myeloblastic leukemia without morphological and cytochemical maturation. M1- Acute myeloblastic leukemia with minimum morphological and cytochemical maturation. M2- Acute myeloblastic leukemia with Maturation. M3 - Acute promyelocytic leukemia, hypergranular

M3m- Acute promyelocytic leukemia,

Microgranular. M4- Acute myelomonocytic leukemia.

M4E0 - Acute myelomonocytic leukemia

with eosinophilia. M5a- Acute monoblastic leukemia, poorly differentiated. M5b- Acute monocyti leukemia, with differentiation

M6- Erythroleukemia
M7- Acute megakaryoblastic leukemia

*
*Harmening, DM. Clinical hematology and
fundamentals of hemostasis. 5th ed. Company, (2007) Philadelphia, PA.

*Ciesla Betty,. Haematology in Practice. F.A. Davis