Predisposing Factors: Age Gender Race Family HIstory Precipitating Factors:  exposure to radiation and certain chemicals  having a sibling with leukemia  HTLV-1 virus  genetic abnormalities  chromosomal translocations


Somatic mutations in the DNA

Activate oncogene/ deactivate tumorsupppresor gene

Malignant transformation of lymphoid stem cells s/sx: bone pain joint pain

Uncontrolled proliferation of lymphoblast in the bone marrow Diagnostic Test: BM aspiration BM biopsy

Treatment: Analgesic

Lymphoblast replace the normal marrow elements

Treatment:  Remission Induction Therapy  Consolidation and Maintenance Therapy  BM Transplantation

Diagnostic Test: CBC

Leukopenia (↓4.36 x 10 /L)

Decreased production of normal blood cells Decreased production of normal blood cells Spillage of lymphoblast into the bloodstream

s/sx: fever, chills seizure


s/sx:  presence of petechiae  bruise & bleed easily  anemia  fatigue  dizziness  palpitations  dyspnea

Treatment:  Blood transfusion  Epoetin and hemapoetic stimulants

Organ infiltration If treated: Antibiotic Ig Leukapheresis If not treated


Prevention of complications



Renal failure     

s/sx: Little/ no UO ↑RR Flank pain Restless n/v legs and feet swelling

Diagnostic Test: MRI Treatment: Intrathecal chemotherapy

CNS s/sx: h/a, weakness, blurred vision, balance difficulty, vomiting, lethargy Liver / Spleen Diagnostic Test: Ultrasonography

leukocyte cells impairs the circulation of CSF

s/sx: ↑ CSF leukocytes s/sx: cranial nerve palsies confusional states optic neuropathy cerebellar dysfunction papilledema

Extra cells cause the liver/spleen to rupture

Diagnostic Test: Spinal Tap

leukocyte cells compresses spinal/ cranial nerves

bleeding Hypovolemic shock

s/sx: hepatomegal y splenomegaly elevated ALT (81 u/L) s/sx: hypotension tachypnea tachychardia

Progress to coma

Overgrown thymus

Compress the Superior Vena Cava

s/sx: shortness of breath cough suffocation

Physical Exam Diagnostic test: Lymph node biopsy

Lymph nodes

Mediastinal lymphadenopathy

s/sx: lymphadenopathy SVC syndrome s/sx:  swelling of head, neck and arms  obstruction of blood flow Treatment:  O2 administration  Bronchodilator s s/sx: cough, wheezes, respiratory tract obstruction

Bronchial/tracheal obstruction Esophageal compression

s/sx: dysphagia

Erosion of node into a bronchus/ trachea

s/sx: hemoptysis

Severe hypoxia