Group 3: Christopher Phipps

Karlene Irwin

Alwyn Coleman

Tamarie Price

*LeukemiaDifferentiating between Acute

and Chronic

*Leukemia

*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.

*Classification of Leukemia

Acute Leukemia Chronic Leukemia

Age group All ages Adults

Clinical onset Sudden Insidious

Course (untreated) Les than 6 months 2-6 years

Leukemic cells Immature Mature

Anemia Mild to severe Mild

Thrombocytopenia Mild to severe Mild

White blood cell count Variable Increased

organomegaly Mild Prominent

*Differentiating between the two

Acute Leukemia:

Proliferation & persistence of mature lymphocytes

*Usually diagnosed incidentally based on high white blood cell counts

*Divided into two groups based on cell of origin:

*Acute Leukemia

Acute Myelogenous

Leukemia

Acute Lyphmhocytic Leukemia

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

*Acute Leukemia

Laboratory findings of Acute Leukemia

* PancytopeniaA blood test may reveal decreased white blood cells, not enough red blood cells and not enough platelets. A blood test may also show the presence of at least 30% blast cells - immature cells normally found in the bone marrow but not circulating in the blood.

Click icon to add picture*Proliferation of blasts

*Disorder originates in a single B or T lymphocyte progenitor

* Laboratory findings of Acute Leukemia

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*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 T-cell 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

* Laboratory findings of Acute Leukemia

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*(AML) occurs froom children up to adults and more commonly in men than women.

*AML is treated with chemotherapy.

*The five-year survival rate is 40%.

* Acute Myeloid Leukemia

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

* Laboratory findings of Acute Leukemia

*Acute myeloid leukemia, without maturation

* Acute Myeloid Leukemia

*Acute myeloid leukemia, with maturation

* Acute Myeloid Leukemia

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*Subtypes of AML include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.

* Acute Myeloid LeukemiaSUBTYPES

Chronic Leukemia:

Proliferation & persistence of mature lymphocytes

*Usually diagnosed incidentally based on high white blood cell counts

*Divided into two groups based on cell of origin:

*Chronic Leukemia

Chronic Myelogenous

Leukemia

Chronic Lyphmhocytic Leukemia

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*Most frequently a neoplasm of B lymphocytes

*Malignant proliferation of T cells less common.

* Chronic Lymphocytic Leukemia

*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

* Chronic lymphocytic leukemia-laboratory findings

*Increased (greater than 10%) prolymphocytes

*Larger proliferative lymphocytes have exaggerated nuclear irregularities, lobulations or nuclear folds

*Increased lymphoplasmacytoid cells (mixed type)

* Chronic Lymphocytic Leukemia

*Neutropenia

*Anemia*Thrombocytopenia

*General pancytopenia due to accumulating lymphocyte mass

* Chronic Lymphocytic Leukemia-laboratory findings cont’d

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*(CML) occurs mainly in adults

*Treatment is with imatinib (Gleevec in US, Glivec in Europe) or other drugs.

*The five-year survival rate is 90%.

*A subtype of CML is chronic monocytic leukemia.

* Chronic Myelproliferative Leukemia

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*Neutrophil maturationseen in CML

* Chronic Myelproliferative Leukemia

*Increased RBC in PV (polycythemia rubra vera)

* Chronic Myelproliferative Leukemia

*Teardrop RBCs in MMM (myeloid metaplasia)

* Chronic Myelproliferative Leukemia

*Increased Thrombocytes in ET

(Essential thrombocythemia)

* Chronic Myelproliferative Leukemia

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*French-American & British

Classification

* Presenter: Karlene Irwin

F.A.B

*

FAB classification of acute myeloid leukemia

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

* References

*Harmening, DM. Clinical hematology and fundamentals of hemostasis. 5th ed.

*Ciesla Betty,. Haematology in Practice. F.A. Davis Company, (2007) Philadelphia, PA.