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Leukemia

Leukemia

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Categories:Types, Research, Science
Published by: viveka_vgo182471 on Dec 07, 2008
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02/17/2013

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LEUKEMIA
 Neoplastic proliferation of WBC in the blood and bone marrow.Acute leukemia-Blast cells-Rapidly fatal if not treatedChronic Leukemia-More mature Cells-Longer life expectancy
CAUSES AND RISK FACTORSSmoking
is a considerable risk factor for leukemia, especially a type of leukemia calledacute myelogenous leukemia, or AML. The carcinogens in cigarettes are absorbed by thelungs and then travel to the bloodstream. It is estimated that 1 in 4 cases of AML arecaused by smoking.
Very high levels of radiation
— People exposed to very high levels of radiation aremuch more likely than others to develop leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) andnuclear power plant accidents (such as the Chernobyl accident in 1986
Working with certain chemicals
— Exposure to high levels of benzene in theworkplace can cause leukemia. Benzene is used widely in the chemical industry.
Chemotherapy
— Cancer patients treated with certain cancer-fighting drugs sometimeslater develop leukemia. For example, drugs known as alkylating agents are associatedwith the development of leukemia many years later.
Down syndrome
and certain other genetic diseases — Some diseases caused byabnormal chromosomes may increase the risk of leukemia. Children and adolescentswith Down's syndrome have a 10 to 30-fold increased incidence of leukemia
Human T-cell leukemia virus-I (HTLV-I)
— This virus causes a rare type of ChronicLymphocytic Leukemia known as Human T-cell leukemia.HTLV II – Hairy cell leukemia
Chromosomal aberration
– observed in ALL & CGL – presence of Philadelphia Chromosome
CLASSIFICATIONACUTE
Acute Myeloblastic Leukemia ( AML)
Acute Lymphoblastic Leukemia ( ALL)
Acute Monoblastic Leukemia ( AMOL)
CHRONIC
Chronic Lymphocytic Leukemia ( CLL)
Chronic Monocytic Leukemia ( CMOL)
 
Chronic Granulocytic Leukemia ( CGL)
ACUTE LEUKEMIA
Found frequently in children and young adults
Incidence - 5 out of 100000
Abrupt onset
Runs a rapidly fatal course
Fever 
Rapidly developing anemia, thrombocytopenia and hemorrhage
Bone pain ( ALL)
Lymphadenopathy (ALL)
Splenomegaly & hepatomegaly
Bleeding gums & bruising
Headache,nausea
 Normochromic normocytic anemia
WBC count –normal / raised
Blast Cells seen in the peripheral blood
Decreased platelet count
Bonemarrow hypercellular with characteristic blast cells
TYPES : AML; ALL; AMOL
ACUTE LYMPHOBLASTIC LEUKEMIA ( ALL)
Proliferation of lymphoblasts
WBC count – 20,000 – 1 lakh /cu mm
> 50 % of the cells are lymphoblasts
They are 1½ times the size of lymphocytes
Smudge cells in the peripheral blood smear 
The most vulnerable section to be affected are children. 1 person per 100,000 affected
Anemia, thrombocytopenia,lymphadenopathy & splenomegaly.
Bone marrow infiltrated with lymphoblasts
25% adults and 3% children diagnosed with ALL have Philadelphia Chromosome
CLINICAL FEATURES
-
Fever , sore throat
-
Enlargement of liver, lymph nodes, spleen
-
Bone pain
ACUTE MYELOBLASTIC LEUKEMIA ( AML)
Cell count – 20000-10000/cu mmIncidence – 1 in 40000 (1in 25,000 people over 50 is at risk from AML, while inthe age group of 70 and above 1 in 7000 people is at risk. )
 
Occurs in adults (People over the age of 50)Peripheral blood - 90% blast cellsCytoplasm of these cells blue with vacuolesNucleus round,2-5 distinct nucleoliNuclear chromatin – fineAuer rods / bodies – in the cytoplasmSwollen, painful, and bleeding gums - if AML has spread to the oral tissue;Pigmented (colored) rash-like spots - if AML has spread to the skin;Poorly differentiated myeloblasts are present.Some contain azurophil granules, but the percentage of maturing granulocytes isless than 10%.Peroxidase stain reveals the Auer rodsPeroxidase stain used to differentiate ALL from AMLAML - Peroxidase positiveALL not Peroxidase positiveSudan Black B - used to differentiate ALL from AMLAML – positive; ALL – negative
ACUTE MONOBLASTIC LEUKEMIA ( AMOL)
Leucocyte count –20000 – 1 lakh / cu mm
Promonocyte and monoblast make up 25 -75% of cells
Monoblasts have muddy / smoggy grey-blue cytoplasm with tiny granules
Cytoplasmic protrusions common
Nucleus – indentation / irregularity with 1 – 5 large nucleoli
Nuclear chromatin – reticulogranular 
Severe thrombocytopenia, nucleated red cells seen
CHRONIC
Occurs in middle aged individualsOnset is gradual (insidious)Anemia slow to developMore differentiated cellsTerminal stages – more blast cells
TYPES
Chronic Granulocytic Leukemia ( CGL)
Chronic Lymphocytic Leukemia ( CLL)
Chronic Monocytic Leukemia ( CMOL)
CHRONIC LYMPHOCYTIC LEUKEMIA ( CLL)
Disease of middle aged and elderly - cases reported in individuals older than 55 yearsWBC count – 2 – 2.5lakhs / cu mm95% small lymphocytes 5% blast cells

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