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LEUKEMIAS History:

Definition Patients with ALL present with either


Neoplastic clonal proliferation of the haemopoetic cell (1) Symptoms relating to direct infiltration of the
lines in the bone marrow with release into circulation of marrow or other organs by leukemia cells or
abnormal cells. (2) Symptoms relating to the decreased production of
Classification normal marrow elements.
Based on clinical presentation -Infiltration of the marrow by massive numbers of
Acute-Rapid onset and progression and without leukemia cells frequently manifests as bone pain.
treatment death in few months 2-3 months. This pain can be severe and is often atypical in
Acute leukemia’s have arrested maturation of the distribution.
haemopoetic cells with predominance of blast cells in -Uncommonly (10-20%), patients may present with left
circulation. upper quadrant fullness and early satiety due to
Chronic-Insidious onset and slow progressing and spenomegaly.
without treatment death in months to years. -Other patients, particularly those with T-cell ALL,
Mature cells and some blasts in circulation-maturation present with symptoms related to a large mediastinal
spectrum of cells. mass, such as shortness of breath.
Based on cell types -Symptoms of leukostasis (eg, respiratory distress,
Lymphoid altered mental status) because of the presence of large
Myeloid types. numbers of lymphoblasts in the peripheral circulation,
leukostasis is much less common in persons with ALL
ACUTE LYMPOBLASTIC LEUKEMIA compared to AML and occurs only in patients with the
Definition highest WBC counts, ie, several hundred thousand per
ALL- is a malignant (clonal) proliferation of early microliter.
lymphoid precursors in the bone marrow with -Symptoms of anemia are common and include fatigue,
replacement the normal hematopoietic cells of the dizziness, palpitations, and dyspnea upon even mild
marrow. exertion.
Pathophysiology: -Patients with ALL often have decreased neutrophil
-The malignant cells of ALL are lymphoid precursor counts, despite an increased total WBC count have
cells (ie, lymphoblast) that are arrested in an early stage increased risk of infection.
of development. -Patients with ALL often have fever without any other
-This arrest is caused by an abnormal expression of evidence of infection.
genes, often as a result of chromosomal translocations. However, in these patients, one must assume that all
-The lymphoblasts replace the normal marrow elements, fevers are from infections until proven otherwise
resulting in a marked decrease in the production of because a failure to treat infections promptly and
normal blood cells. Consequently, anemia, aggressively can be fatal. Infections are still the most
thrombocytopenia, and neutropenia occur to varying common cause of death in patients undergoing treatment
degrees. for ALL
-The lymphoblasts also proliferate in organs other than -Bleeding symptoms due to thrombocytopenia .The
the marrow, particularly the liver, spleen, and lymph thrombocytopenia, however, tends to be less severe than
nodes. that observed in patients with AML
Frequency: -Some may have (DIC) at the time of diagnosis, usually
ALL is the most common type of leukemia in children. as a result of sepsis.
In adults, it is less common than acute myelogenous Consequently, some patients may present with
leukemia (AML) hemorrhagic or thrombotic complications.
Mortality/Morbidity: -Signs relating to leukostasis include respiratory
Only 20-40% of adults with ALL are cured with current distress and altered mental status
regimens.
ALL in pediatrics is more responsive.
Sex:
ALL is slightly more common in men than in women.
Age:
ALL is more common in children than in adults

Physical:
-Patients commonly have physical signs of anemia, Procedure
including pallor and a cardiac flow murmur. Bone marrow aspiration and biopsy are the definitive
-Fever and other signs of infection, including lung diagnostic tests to confirm the diagnosis of leukemia.
findings of pneumonia, can occur. Tests
-Thrombocytopenia usually demonstrate petechiae, Cytochemical Staining
particularly on the lower extremities. Positive TdT- terminal deoxynucleotidyl transferase and
A large number of ecchymoses is usually an indicator of PAS (Periodic Acid Schiff) is the hallmark of ALL. ALL
a coexistent coagulation disorder such as DIC. is negative to myeloperoxiadase and Sudan black
-Signs relating to organ infiltration with leukemia cells TdT also helps distinguish ALL from malignancies of
include hepatosplenomegaly and, to a lesser degree, more mature lymphocytes (ie, NHL).
lymphadenopathy. Immunophenotying /Flow cytometry-Cell markers
-Occasionally, patients have rashes resulting from Positive confirmation of lymphoid (and not myeloid)
infiltration of the skin with leukemic cells. lineage by flow cytometric demonstration of lymphoid