CASE

PRESENTATION
BY: GROUP 5
NIKITHA
BHAVYA
ASRAR
RANJITHA
INTRODUCTION

LEUKEMIA (Cancer of Bone Marrow)

• Leukemia is a clonal malignant neoplasm of the
hematopoietic stem cells characterised by the
proliferation of abnormal blast cells and impaired
production of normal red cells.
• Leukemia is classified on the basis of the cell type involved
and the state of maturity of the leukemic cells into 2 types
– Acute and Chronic. They are further classified into
Myeloid and Lymphoid leukemia based on the origin of
the leukemic stem cells.

ACUTE LEUKEMIA - In this there is accumulation of blasts

(immature malignant blood cell precursors) in the bone
marrow which may spill over into the peripheral blood. They
have rapid onset and the disease progression is also rapid.
If not treated the patient dies within weeks to months of
diagnosis.
• In acute leukemia, the blast count in the bone marrow is
always >20% (FAB criteria for the diagnosis of acute
leukemia).The blasts of the bone marrow and spills over
into the peripheral blood.
• Acute leukemia are categorised into acute myeloid
leukemia or acute lymphoid leukemia depending on the
nature of the blast.
• The presence of cytoplasmic granules, Auer rods and the
fine nature of the chromatin are useful morphological
features help in differentiating a myelobast from a
lymphoblast.
• Cytochemical stains like Myeloperoxidase(MPO), Sudan
black B (SBB), Specific and nonspecific esterases helps in
differentiating a myeloblast from a lymphoblast.
• Based on the morphology of the blasts AML (Acute Myeloid
Leukemia) is classfied into 8 subtypes M0 to M7
• While ALL (Acute Lymphoid Leukemia) is classified into 3
subtypes L1, L2, L3
• FAB (French American and British) has defined 3
subtypes of ALL based on the morphology and
heterogeneity of the blasts.
CHRIONIC LEUKEMIA – In this the malignant clone is able to
differentiate, resulting in accumulation of more mature cells.
They have an insidious onset and the disease progression is
slow. The course of the disease is long and measured in
years.
• Chronic Leukemia are Catagorised into Chronic Lymphoid
Leukemia and Chronic Myeloid Leukemia.
CAUSES OF LEUKEMIA

a) Genetic susceptibility – Risk is high in Down’s syndrome and

in various congenital disorder like Klinfelter’s syndrome.
b) Genetic mutations – Caused by exposure to ionising
radiations, chemical toxins, and anticancer drugs.
c) Viral infections – Retroviral infections like HTLV-1 (Human T
cell leukemia/ lymphoma virus) are proven to cause T cell
malignancy.
d) Congenital and acquired immunologic disorders – A few
conditions like AIDS are commonly associated with
leukemia.
SYMPTOMS
• In acute leukemia, the abnormal cells may collect in the
brain or spinal cord. The result may be headaches,
vomiting, confusion, loss of muscle control, and seizures.
Leukemia cells also can collect in the testicles and cause
swelling. Also, some patients develop sores in the eyes or
on the skin or mouth. Leukemia also can affect the
digestive tract, kidneys, lungs, or other parts of the body.

• In chronic leukemia, the abnormal blood cells may

gradually collect in various parts of the body.
CASE
HS
ITORY

• Name : Rahul s/o Sreenath

• Age : 10 Yrs
• Sex : Male

• Chief complain : Fever since 2 months

Pain in throat since 10 days
HISTORY OF PRESENT ILLNESS
• Patient has fever for 2 months. It is
persistent type, dull in nature, low grade
fever. Slightly decreased by taking Tablet
Paracetamole.

• Patient has started throat pain for 10 days

with difficulty in breathing.
PAST HISTORY
• No H/O same disease in past.
• No H/O Previous surgery.
• No H/O Chronic Illness.
PERSONAL HISTORY
• Delivered by C-Section.
• At birth baby weight : 2.2Kg
• Patient is pure vegetarian.
• No H/O any drug allergy.
• Fully vaccinated as schedule.
• No H/O diarrhoea, vomitting.
EXAMINATION
• Awake, conscious, oriented, restless and anxious.
• Pallor ++
• Spleenomegaly
• Cervical Lymphadenopathy
• Icterus, Cyanosis.
• PR : 120/min Regular, Normal volume in character.
• All peripheral pulses palpable.
• BP : 100/70 mm Hg
• Temperature febrile on touch.
• Respiration is laboured and rate 28/min.
• Heart sound is normal.
• Petechiae spots, Splinter hemorrhages and
bilateral conjuctival hemorrhage present.
• There is large swelling all around the neck
and on face.
• Tongue is swollen and oral mucosa is
edematous with bluish discoloration
suggestive of hematoma.
INVESTIGATION
• Hemoglobin : 5.5 gm/dl
• Differential leucocyte count : Lymphocytes 55, Eosinophil 3,
Monocytes 2, Blast cells 20%; Reticulocytes 0.2%
• Platelet count 30,000 / cmm
• Bone marrow examination showed large predominantly
heterogenous blast cells.
• Blood culture was sterile
• Widal test Negative
• RFT / LFT normal range
• ECG – Bradycardia (Slow heart rate)
 QUESTIONS
1. What is the provisional diagnosis made?
Acute Lymphoid Leukemia.(ALL TYPE 2)

2. What are the expected peripheral smear findings?

RBC’S are normocytic normochromic cells, WBC is
usually increased but may be normal or decreased
with the circulating blasts being lymphoblasts.

3. What are the other conditions associated with ALL?

Anaemia, Thrombocytopenia, Organomegaly.
4. Mention some cytochemical stains used to confirm
the diagnosis.
Myeloperoxidase (MPO) – Negative
Sudan Black B – Negative

5. The blast count in the bone marrow is always greater

than
>20%

6. What is the morphological feature of a Lymphoblast?

Cytoplasmic granules absent, Auer rods absent,
Chromatin variably condensed, Nucleolus 1-2 may be
less prominent.