Leukaemias
Leukaemias: Malignant Disease of WBC Forming tissue: Lymphoblastic (ALL) Acute Myeloid (AML) Lymphatic (CLL) Chronic Myeloid (CML)Acute Leukaemias
Defind pathologically as blast cell leukaemia It is a malignancy of immature haemopoietic cells The bone marrow shows >30% blast cellsTypes Of Acute leukaemia
1.Acute lymphoblastic leukaemia (ALL) 2.Acute Myeloblastic leukaemia (AML)Pathology:
BLAST CELLSTissue invasion (L.N., spleen, liver, skin, C.N.S)
BLOOD Pancytopenia + Blastaemia Normal Haemopoiesis (Depressed)
Bone Marrow
Blood Picture: Hb Clinically (Normochromic - - - - Pallor, Tiredness Anaemia - - - - Dyspnea, etc. . . =4-9 g/dl) DIC (AProl) Platelet Count - - - Bleeding (Thrmbocytopenia Tendency = 10 – 80 x 109/L) Neutrophil - - - Infections count (Fever, septicoemia) ( 0.1 – 1.5 x 109/L)Organ infiltration: Lymphadenopathy (systemic) Hepatosplenomegaly - Gum Hypertrophy in Monocytic leukaemia (rarely, skin, bone, C.N.S) Viral Fungal Bacterial
Total WBC count Normal, low, or increased
Acute leukaemia
Dr. Bashar Department of Pathology Mosul Medical CollegeIt is rare before 40 years of age, the median age of onset being 50-60 years. It accounts for almost 50% of Leukaemias occurring after the age of 60 years .in most cases the initial leukaemic proliferation is readily controlled by drugs, but many patients with CLL remain well without treatment.
Blood Picture
The outstanding feature is a marked increase in leucocytes ,often 100x10^9/l or higher ,nearly all are mature small lymphocytes .although the disease appears to originate in marrow ,pancytopenia is a late feature .however ,autoimmune haemolytic anaemia & thrombocytopenia occur as early complications in about 10% of the cases .Diagnosis
1. A persistent circulating lymphocyte count of >5x10^9/l. 2. BM lymphocytosis >30%.Course
The clinical course is extremely variable: it may be rapidly progressive with a fatal outcome in 1-2 years or it may be static over decades.
Chronic Lymphocytic Leukaemia ( CLL )
Increased WBCs Absolute lymphocytosis. Lymphocytes are mature looking with frequent torn cells ( smear cells), note the presence of a prolymphocyteWhile the commonest in adults of 30-40 years,the disease can occur at any age.
ClinicallyGross splenomegaly & hepatomegaly. Signs of impaired marrow function such as anaemia or thrombocytopenia are inconspicuous till late in the disease, after variable period ,usually several years ,ANLL or common ALL supervene.
The Philadelphia Chromosome It is reciprocal translocation of parts of the long arms of chromosome 9and 22, t(9;22) (q34;q11).in approximately 90% of CGL patients the Ph chromosome can be identified in marrow cell metaphases, and they have a median survival of 42 months where as the remainder Ph negative & have only a 15 months median survival.