I.

INTRODUCTION
Acordding to Cleveland Clinic:
Blood cancer affects how your body produces blood cells and how well those cells work. Most blood cancers start in
your bone marrow, the soft, sponge-like material in the center of your bones. Your bone marrow makes stem cells
that mature and become red blood cells, white blood cells and platelets.
Normal blood cells fight infection, carry oxygen throughout your body and control bleeding. Blood cancer happens
when something disrupts how your body makes blood cells. If you have blood cancer, abnormal blood cells
overwhelm normal blood cells, creating a ripple effect of medical conditions. More people are living longer with
blood cancer, as healthcare providers find new ways to treat it.
Acordding To Hematology.Org:
Blood cancers affect the production and function of your blood cells. Most of these cancers start in your bone
marrow where blood is produced. Stem cells in your bone marrow mature and develop into three types of blood
cells: red blood cells, white blood cells, or platelets. In most blood cancers, the normal blood cell development
process is interrupted by uncontrolled growth of an abnormal type of blood cell. These abnormal blood cells, or
cancerous cells, prevent your blood from performing many of its functions, like fighting off infections or preventing
serious bleeding.
Acordding To Webmd:
Blood cancers affect blood cells and bone marrow -- the spongy tissue inside your bones where blood cells are made.
These cancers change the way blood cells behave and how well they work. 
You have three types of blood cells:

 White blood cells fight infection as part of your immune system.

 Red blood cells carry oxygen to your body's tissues and organs and bring carbon dioxide to your lungs so you can
breathe it out.
 Platelets help your blood clot when you're injured.
There are three major types of blood cancer:

 Leukemia
 Lymphoma
 Myeloma
These cancers cause your bone marrow and lymphatic system to make blood cells that don't work as well as they should.
They all affect different types of white blood cells, and they act in different ways.
Blood cancers are serious illnesses, but other cancer types are more deadly. Blood cancers represent about 10% of
all cancers diagnosed in the United States each year, and an estimated 3% of all cancer-related deaths. National
Cancer Institute data show a steady decline in blood cancer deaths.
Survival rates are estimates based on averages. Your healthcare provider may share five-year survival rates as a way
of explaining how your blood cancer may affect your health five years after diagnosis. Survival rates are different for
each of the three blood cancer types, but many people who have blood cancer can expect to survive as long as most
other people.
TYPES OF BLOOD CANCERS:

There are three main types of blood cancers:

 Leukemia, a type of cancer found in your blood and bone marrow, is caused by the rapid production of
abnormal white blood cells. The high number of abnormal white blood cells are not able to fight infection,
and they impair the ability of the bone marrow to produce red blood cells and platelets.
 Lymphoma is a type of blood cancer that affects the lymphatic system, which removes excess fluids from
your body and produces immune cells. Lymphocytes are a type of white blood cell that fight infection.
Abnormal lymphocytes become lymphoma cells, which multiply and collect in your lymph nodes and other
tissues. Over time, these cancerous cells impair your immune system.

 Myeloma is a cancer of the plasma cells. Plasma cells are white blood cells that produce disease- and
infection-fighting antibodies in your body. Myeloma cells prevent the normal production of antibodies,
leaving your body's immune system weakened and susceptible to infection. 
II. DEFINITION OF TERMS

ABO: The most important of several blood group systems for typing human blood, based on the presence or
absence of two antigens (A and B) on the surface of red blood cells. Blood types are A, B, AB, and O.

Allogeneic: Transfusion of blood from a person other than the recipient, (i.e., NOT autologous). Same as
homologous.

Anemia: Condition in which the red cell content of the blood is below normal limits. Most common cause is a
deficiency of iron, an element necessary for the formation of hemoglobin.

Antibody: A protein produced by the immune system in response to a specific foreign substance (antigen) that
attempts to eliminate the foreign substance from the body.

Antigen: A protein or carbohydrate substance that is recognized by the body as foreign that stimulates an immune
response.

Apheresis: An automated method of separating platelets, plasma, or red blood cells from the donor’s blood and
returning all but that component to the donor. Also known as Apheresis Blood Collection, or ABC.

Autologous Donation: From auto (self) and logos (relation), it is a blood donation you give for your own surgery or
medical needs.

Bone Marrow: The site of blood cell production, found within bone cavities.
Cholesterol: Complex chemical present in all animal fats and widespread in the body and nerve fiber sheaths.

Convalescent Plasma: Plasma donated by individuals who have recovered from an infectious disease may contain
antibodies against that specific pathogen. Since antibodies are crucial for immunity against many diseases, the
units of this potentially antibody-rich plasma are sometimes transfused into patients currently battling that same
infectious agent.

Cryoprecipitate: Component of blood obtained by freezing and thawing plasma. Useful in replacing some clotting
factors in patients missing them congenitally or because of operation or trauma.

Cytomegalovirus (CMV): About half of all donors have antibodies to this virus. Although the virus does not cause
significant illness in healthy individuals, CMV may cause severe infection in transplant recipients and other
patients whose immune systems are impaired. Other patients can safely receive blood that has this antibody.

Directed Donation: A blood donation for a specific person. The patient’s physician must give the order for
donation.

Erythrocytes: a red blood cell that (in humans) is typically a biconcave disc without a nucleus. Erythrocytes contain
the pigment hemoglobin, which imparts the red color to blood, and transport oxygen and carbon dioxide to and
from the tissues.

Hematocrit: Measure of the volume of red blood cells as a percentage of the total blood volume.

Hemoglobin: An iron-containing protein pigment occurring in the red blood cells and functioning primarily in the
transport of oxygen from the lungs to the body tissues.

Hepatitis: Inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights
infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some
medications, and certain medical conditions can cause hepatitis.

Homologous: Transfusion of blood from a person other than the recipient (i.e., NOT autologous). Same as
allogeneic.

Leukocytes: Leukocytes are part of the body's immune system. They help the body fight infection and other
diseases. Types of leukocytes are granulocytes (neutrophils, eosinophils, and basophils), monocytes, and
lymphocytes (T cells and B cells).

Leukoreduced: Blood in which white cells have been reduced in number, usually by filtration.

Plasma: The yellow fluid portion of the blood in which the red cells, white cells, and platelets are suspended. Like
other blood components, it can be separated out from the whole blood for use in component therapy. Plasma
contains many clotting proteins.

Platelets: Disk-shaped structures found in the blood of all mammals, playing a major role in the coagulation of
blood. Patients undergoing treatment for cancer are the primary users of platelets.

Rh factor: An antigen present on the red blood cells of about 85% of people. Called Rh because it was first
identified in the blood of rhesus monkeys. Persons with the factor are designated Rh-positive, those lacking the
factor are designated Rh-negative.
III. EPIDEMIOLOGY
General Blood Cancers
New Cases

 Approximately every 3 minutes, one person in the US is diagnosed with leukemia, lymphoma or myeloma.
 An estimated combined total of 186,400 people in the US are expected to be diagnosed with leukemia,
lymphoma or myeloma in 2021.
 New cases of leukemia, lymphoma and myeloma are expected to account for 9.8 percent of the estimated
1,898,160 new cancer cases that will be diagnosed in the US in 2021.
Prevalence

 Prevalence is the estimated number of people alive on a certain date in a population who previously had a
diagnosis of the disease. An estimated 1,519,907 people in the United States (US) are living with or in
remission from leukemia, lymphoma, myeloma, myelodysplastic syndromes (MDS) or
myeloproliferative neoplasms (MPNs). 
Survival

 Relative survival compares the survival rate of a person diagnosed with a disease to that of a person without
the disease. The most recent survival data available may not fully represent the outcomes of all current
therapies and, as a result, may underestimate survival to a small degree. 
Deaths

 Approximately every 9 minutes, someone in the US dies from a blood cancer.* This statistic represents
approximately 158 people each day or more than six people every hour.
 Leukemia, lymphoma and myeloma are expected to cause the deaths of an estimated 57,750 people in the US
in 2021.
 These diseases are expected to account for 9.5 percent of the deaths from cancer in 2021, based on the
estimated total of 608,570 cancer deaths.
Leukemia
New Cases

 In 2021, 61,090 people are expected to be diagnosed with leukemia.

Prevalence

 An estimated 397,501 people are living with or in remission from leukemia in the US.
Survival

 The 5-year relative survival rate for leukemia has more than quadrupled, from 14 percent in whites from 1960
to 1963 (the only data available) to 66.4 percent for all races from 2010 to 2016.
 From 2010 to 2016, the five-year relative survival rates overall were

o ALL – 72.1 percent overall, 92.5 percent for children and adolescents younger than 15 years, and
94.4 percent for children younger than 5 years
o AML – 29.8 percent overall and 70.6 percent for children and adolescents younger than 15 years
o CLL – 88.6 percent
o CML – 71.7 percent*
Deaths
  Approximately 23,660 deaths (13,900 males and 9,760 females) in the US are expected to be attributed to
leukemia in 2021.
 From 2013 to 2017, leukemia was the sixth most common cause of cancer deaths in males and the seventh
most common cause of cancer deaths in females in the US.
Hodgkin (HL) and Non-Hodgkin (NHL) Lymphoma
New Cases

 About 90,390 people in the United States (US) are expected to be diagnosed with lymphoma in 2021 (8,830
cases of HL and 81,560 cases of NHL).
Prevalence

 There are an estimated 825,651 people living with, or in remission from, lymphoma in the US.

o There are 152,671 people living with or in remission from Hodgkin lymphoma
o There are 672,980 people living with or in remission from non-Hodgkin lymphoma
Survival

 The 5-year relative survival rate for people with HL has more than doubled, from 40 percent in whites from
1960 to 1963 (the only data available) to 89.6 percent for all races from 2010 to 2016. The 5-year relative
survival rate is 95.1 percent for all people with HL who were younger than 45 years at diagnosis.

o HL is now considered to be one of the most curable forms of cancer.

 The 5-year relative survival rate for people with NHL has risen from 31 percent in whites from 1960 to 1963
(the only data available) to 75.1 percent for all races from 2010 to 2016. The 5-year relative survival rate is
84.7 percent for all people with NHL who were younger than 45 years at diagnosis.
Deaths

 In 2021, an estimated 21,680 members of the US population are expected to die from lymphoma (960 HL and
20,720 NHL).

Myeloma
New Cases

 An estimated 34,920 new cases of myeloma (19,320 males and 15,600 females) are expected to be diagnosed
in the US in 2021.
Prevalence

 An estimated 138,415 people in the United States (US) are living with or in remission from myeloma.
Survival

 Five-year relative survival increased from 12 percent from 1960 to 1963 (for whites, the only data available) to
55.1 percent from 2010 to 2016 (for all races and ethnicities).
 The 3-year survival rate as of January 1, 2017, was 69.1 percent (for all races and ethnicities). 
 The 5-year survival rate is 76.8 percent for people with myeloma who were younger than 45 years at
diagnosis.
Deaths

 Approximately 12,410 deaths from myeloma are expected in 2021.

Myelodysplastic Syndromes (MDS)
New Cases

 For the 5-year period from 2013 to 2017, there were 75,497 new cases of MDS throughout the United States
(US), averaging 15,099 cases per year.
Prevalence
 An estimated 58,471 people in the US are living with or in remission from MDS. 
Survival

 For 2010-2016, the 5-year relative survival rate for MDS was 38.3 percent.
Deaths

 The SEER report reflects mortality data from the National Cancer for Health Statistics (NCHS) database, in
which MDS is not included as a cause of death. Therefore, mortality statistics were not reported in 2021 at the
time of the Facts 2020-2021 publication.
Myeloproliferative Neoplasms
New Cases
For the 5-year period from 2013 to 2017, there were 61,572 new cases of MPNs throughout the United States (US),
averaging 12,314 cases per year.
Prevalence
An estimated 99,869 people in the United States (US) are living with or in remission from MPNs.
Survival
For 2010-2016, the 5-year relative survival rate for MPNs was 85.0 percent.
Deaths

 The SEER report reflects mortality data from the National Cancer for Health Statistics (NCHS) database, in
which MDS is not included as a cause of death. Therefore, mortality statistics were not reported in 2021 at
the time of the Facts 2020-2021 publication.
IV. ETIOLOGY

Researchers know blood cancer happens when blood cell DNA changes or mutates, but they aren’t sure why this
happens. Your DNA tells cells what to do. In blood cancer, DNA tells blood cells when to grow, when to divide or
multiply and/or when to die.

When DNA gives your cells new instructions, your body develops abnormal blood cells that grow and multiply faster
than normal and sometimes live longer than normal. When that happens, normal blood cells become lost in an ever-
growing horde of abnormal cells that crowd your normal cells and monopolize space in your bone marrow.

Eventually, your bone marrow produces fewer normal cells. That means there aren’t enough normal cells available
to do their essential tasks: carrying oxygen through your body, fighting infection and controlling bleeding. Here’s
how genetic change may cause the three blood cancer types:

 Leukemia: Researchers think leukemia happens when a combination of environmental and genetic factors
triggers DNA changes. In this case, researchers think changes in chromosomes may trigger DNA changes.
Chromosomes are strands of DNA. When cells divide and make two new cells, they copy these DNA strands.
Sometimes, genes from one chromosome switch to another chromosome. In leukemia, this switch may
affect a set of genes that help cells grow and another set of genes that suppress tumors. Researchers believe
exposure to high levels of radiation or certain chemicals plays a role in the genetic changes that cause
leukemia.
 Lymphoma: Lymphoma happens when there’s a change in genes in white blood cells, called lymphocytes,
that causes them to multiply uncontrollably. In addition, abnormal lymphocytes don’t die when normal
lymphocytes die. Again, researchers don’t know what triggers the genetic change, but research shows
certain infections or having a depressed immune system may be factors.
 Myeloma: In this case, plasma cells in your bone marrow get new genetic instructions that make them
multiply. Researchers are investigating potential links between myeloma and chromosomal change that
affect genes that control plasma cell growth.

V. RELATED ANATOMY, PHYSIOLOGY, AND KINESIOLOGY

Your heart is an amazing organ. It continuously pumps oxygen and nutrient-rich blood throughout your body to sustain
life. This fist-sized powerhouse beats (expands and contracts) 100,000 times per day, pumping 5 or 6 quarts
of blood each minute, or about 2,000 gallons per day.

Your heart is made of muscle. When the strong muscular walls contract (squeeze), it pumps blood to the arteries.
Photo Credit: WebMD

As the heart beats, it pumps blood through a system of blood vessels, called the circulatory system. The vessels are
elastic tubes that carry blood to every part of the body.
Blood is essential. In addition to carrying fresh oxygen from the lungs and nutrients to your body's tissues, it also takes
the body's waste products, including carbon dioxide, away from the tissues. This is necessary to sustain life and promote
the health of all the body's tissues.
There are three main types of blood vessels:

 Arteries. They begin with the aorta, the large artery leaving the heart. Arteries carry oxygen-rich blood away
from the heart to all of the body's tissues. They branch several times, becoming smaller and smaller as they carry
blood farther from the heart.
 Capillaries. These are small, thin blood vessels that connect the arteries and the veins. Their thin walls allow
oxygen, nutrients, carbon dioxide, and other waste products to pass to and from our organ's cells.
 Veins. These are blood vessels that take blood back to the heart; this blood lacks oxygen (oxygen-poor) and is
rich in waste products that are to be excreted or removed from the body. Veins become larger and larger as
they get closer to the heart. The superior vena cava is the large vein that brings blood from the head and arms to
the heart, and the inferior vena cava brings blood from the abdomen and legs into the heart.

Blood flows continuously through your body's blood vessels. Your heart is the pump that makes it all possible.
The heart is under the rib cage, to the left of your breastbone (sternum) and between your lungs.
Looking at the outside of the heart, you can see that the heart is made of muscle. The strong muscular walls contract
(squeeze), pumping blood to the arteries. The major blood vessels connected to your heart are the aorta, the superior
vena cava, the inferior vena cava, the pulmonary artery (which takes oxygen-poor blood from the heart to the lungs
where it is oxygenated), the pulmonary veins (which bring oxygen-rich blood from the lungs to the heart), and the
coronary arteries (which supply blood to the heart muscle).
On the inside, the heart is a four-chambered, hollow organ. It is divided into the left and right side by a wall called the
septum. The right and left sides of the heart are further divided into two top chambers called the atria, which receive
blood from the veins, and two bottom chambers called ventricles, which pump blood into the arteries.
The atria and ventricles work together, contracting and relaxing to pump blood out of the heart. As blood leaves each
chamber of the heart, it passes through a valve. There are four heart valves within the heart:

 Mitral valve
 Tricuspid valve
 Aortic valve
  Pulmonic valve (also called pulmonary valve)

The tricuspid and mitral valves lie between the atria and ventricles. The aortic and pulmonic valves lie between the
ventricles and the major blood vessels leaving the heart.
The heart valves work the same way as one-way valves in the plumbing of your home. They prevent blood from flowing
in the wrong direction.
Each valve has a set of flaps, called leaflets or cusps. The mitral valve has two leaflets; the others have three. The leaflets
are attached to and supported by a ring of tough, fibrous tissue called the annulus. The annulus helps to maintain the
proper shape of the valve.
The leaflets of the mitral and tricuspid valves are also supported by tough, fibrous strings called chordae tendineae.
These are similar to the strings supporting a parachute. They extend from the valve leaflets to small muscles, called
papillary muscles, which are part of the inside walls of the ventricles.

Blood Flow Through the Heart

The right and left sides of the heart work together. The pattern described below is repeated over and over, causing blood
to flow continuously to the heart, lungs, and body.
Right side of the heart

 Blood enters the heart through two large veins, the inferior and superior vena cava, emptying oxygen-poor
blood from the body into the right atrium.
 As the atrium contracts, blood flows from your right atrium into your right ventricle through the open tricuspid
valve.
 When the ventricle is full, the tricuspid valve shuts. This prevents blood from flowing backward into the atria
while the ventricle contracts.
 As the ventricle contracts, blood leaves the heart through the pulmonic valve, into the pulmonary artery, and to
the lungs where it is oxygenated.

Left side of the heart

 The pulmonary vein empties oxygen-rich blood from the lungs into the left atrium.
 As the atrium contracts, blood flows from your left atrium into your left ventricle through the open mitral valve.
 When the ventricle is full, the mitral valve shuts. This prevents blood from flowing backward into the atrium
while the ventricle contracts.
 As the ventricle contracts, blood leaves the heart through the aortic valve, into the aorta, and to the body.

Blood Flow Through Your Lungs

Once blood travels through the pulmonic valve, it enters your lungs. This is called the pulmonary circulation. From your
pulmonic valve, blood travels to the pulmonary artery to tiny capillary vessels in the lungs.
Here, oxygen travels from the tiny air sacs in the lungs, through the walls of the capillaries, into the blood. At the same
time, carbon dioxide, a waste product of metabolism, passes from the blood into the air sacs. Carbon dioxide leaves the
body when you exhale. Once the blood is purified and oxygenated, it travels back to the left atrium through the
pulmonary veins.

Coronary Arteries
Like all organs, your heart is made of tissue that requires a supply of oxygen and nutrients. Although its chambers are full
of blood, the heart receives no nourishment from this blood. The heart receives its own supply of blood from a network
of arteries, called the coronary arteries.
Two major coronary arteries branch off from the aorta near the point where the aorta and the left ventricle meet:

 The right coronary artery supplies the right atrium and right ventricle with blood. It usually branches into the
posterior descending artery, which supplies the bottom portion of the left ventricle and back of the septum with
blood.
  The left main coronary artery branches into the circumflex artery and the left anterior descending artery. The
circumflex artery supplies blood to the left atrium, side, and back of the left ventricle, and the left anterior
descending artery supplies the front and bottom of the left ventricle and the front of the septum with blood.

These arteries and their branches supply all parts of the heart muscle with blood.
When the coronary arteries narrow to the point that blood flow to the heart muscle is limited (coronary artery disease),
a network of tiny blood vessels in the heart that aren't usually open called collateral vessels may enlarge and become
active. This allows blood to flow around the blocked artery to the heart muscle, protecting the heart tissue from injury.

The Heart Beat

The atria and ventricles work together, alternately contracting and relaxing to make the heart beat and pump blood. The
electrical system of your heart is the power source that makes this possible.
Your heartbeat is triggered by electrical impulses that travel down a special pathway through your heart.

 The impulse starts in a small bundle of specialized cells called the SA node (sinoatrial node), in the right atrium.
This node is known as the heart's natural pacemaker. The electrical activity spreads through the walls of the
atria and causes them to contract.
 A cluster of cells in the center of the heart between the atria and ventricles, the AV node (atrioventricular node)
is like a gate that slows the electrical signal before it enters the ventricles. This delay gives the atria time to
contract before the ventricles do.
 The His-Purkinje network is a pathway of fibers that sends the impulse to the muscular walls of the ventricles,
causing them to contract.

At rest, a normal heart beats around 50 to 99 times a minute in an adult. Exercise, emotions, fever, and
some medications can cause your heart to beat faster, sometimes to well over 100 beats per minute.

Platelet

Platelets clump and form a plug in the damaged area of a torn blood vessel to stop blood loss.

The heart pumps blood through a vast network of arteries and veins. Blood is a living fluid. It transports oxygen and
other essential substances throughout the body, fights sickness, and performs other vital functions. Below are 8
important facts about blood.

1. Blood Is Fluid Connective Tissue

Blood is composed of 55% plasma and 45% “formed elements,” including red blood cells, white blood cells, and
platelets. Because of these living cells suspended in the plasma, blood is considered a fluid connective tissue (not a
fluid). It is the only fluid tissue in the body.

2. Blood Provides the Body's Cells with Oxygen and Removes Carbon Dioxide

Blood absorbs oxygen from air in the lungs. It transports the oxygen to cells throughout the body, and it removes
waste carbon dioxide from the cells. In the lungs, the carbon dioxide moves from the blood to the air and is exhaled.

3. Blood Transports Nutrients and Hormones

Blood plays a large role in digestion and endocrine system functions. Digested nutrients are absorbed into the
bloodstream through capillaries in the villi that line the small intestine. These nutrients include glucose, amino acids,
vitamins, minerals, and fatty acids. Blood also transports some hormones secreted by endocrine system glands to
target organs and tissues.
4. Blood Regulates Body Temperature

Blood absorbs and distributes heat throughout the body. It helps to maintain homeostasis through the release or
conservation of warmth. Blood vessels expand and contract when they react to outside organisms, such as bacteria,
and to internal hormone and chemical changes. These actions move blood and heat closer to or farther from the skin
surface, where heat is lost.

5. Platelets Clot Blood at Sites of Injury

When a blood vessel tears, platelets and plasma proteins work together to stop blood loss. Platelets, also
called thrombocytes, clump and form a plug in the damaged area. The proteins form threads called fibrins to
complete the platelet plug, or clot.

6. Blood Brings Waste Products to the Kidneys and Liver

Blood transports waste substances to the organs that remove and process them for elimination. Blood flows into the
kidneys through the renal arteries and out through the renal veins. The kidneys filter substances such as urea, uric
acid, and creatinine out of the blood plasma and into the ureters. The liver also removes toxins from blood. During
digestion, it cleans blood that has been enriched with vitamins before sending it back out to the rest of the body.

7. Red Blood Cells Are the Most Numerous Living Cells in Blood

Blood is 55% plasma and 45% formed elements. Red blood cells, also called erythrocytes, make up most of that 45%.
Their primary function is to transport oxygen from the lungs to the cells of the body. Red blood cells are disc-shaped.
They are flexible and bioconcave—flat and round with depressed centers.

8. White Blood Cells Protect the Body from Pathogens

White blood cells, also called leukocytes, are the disease-fighting components of blood. They account for just 1% of
circulating blood but multiply during infection or inflammation. There are five types of white blood cells: neutrophils,
eosinophils, basophils, lymphocytes, and monocytes. Neutrophils are the most abundant, comprising 60% to 70% of
all white blood cells.
VI. PATHOPHYSIOLOGY
Bone marrow is responsible for the making of red blood cells (RBC), white blood cells (WBC) and platelets.
In leukaemia, due to the immature cells or some defect in the cells of the bone marrow, the abnormal and
functionless WBC are produced which are unable to fight against the infection and defend the body against
foreign substances.

Also, they obstruct the production of other blood cells by dividing quickly and crowding among normal cells.
Myelogenous vs. Lymphocytic Leukemia
All of the blood cells derive from pluripotential stem cells in the bone marrow thanks to a process called
hematopoiesis. These cells differentiate into either

1. Myeloid cells (the myeloid cell line). Myeloid cells differentiate into red blood cells, platelets, and the
type of cells found in myeloid leukemia: neutrophils, monocytes, and more.
2. Lymphoid cells differentiate into either B lymphocytes (B cells) or T lymphocytes (T cells), and
lymphocytic leukemias may begin in either of these cell types.
Leukemia occurs due to the malignant transformation of pluripotent (i.e., it can give rise to both myeloid and
lymphoid precursors) hematopoietic stem cells. Rarely, it can also involve a more committed stem cell with limited
self-renewal capacity. In acute leukemias, these malignant cells are generally immature, poorly differentiated,
abnormal leukocytes (blasts) that can either be lymphoblasts or myeloblasts. These blasts can undergo clonal
expansion and proliferation, leading to replacement and interference with the development and function of normal
blood cells, leading to clinical symptoms. 
Acute Leukemia
In ALL, chromosomal translocation or abnormal chromosome numbers can lead to mutations in precursor lymphoid
cells leading to lymphoblasts. Common mutations include t(12;21) and t(9;22). In AML, chromosomal translocations,
rearrangements, and gain or loss of chromosomes can lead to mutations and abnormal production of myeloblasts.
One important translocation is t(15;17), which leads to the fusion of retinoic acid receptor alpha (RARA) and a
promyelocytic leukemia transcription factor (PML). This leads to the development of acute promyelocytic leukemia,
which can present with hallmarks of disseminated intravascular coagulation and need emergent treatment with all-
trans retinoic acid.
Chronic Leukemia
Chromosomal abnormalities in hematopoietic stem cells that are precursors to leucocytes are the most common
cause of chronic leukemia. Examples of abnormalities are deletions, translocations, or extra chromosomes. In CML,
mutations mainly affect granulocytes (most commonly the t(9;22) translocation), and in CLL, they primarily affect
lymphocytes (especially B lymphocytes). Unlike acute leukemias, in chronic leukemias, cells are partially mature.
These partially mature cells do not function effectively and divide too quickly. They accumulate in the peripheral
blood and lymphoid organs, which can lead to anemia and thrombocytopenia, and leukopenia. 

VII. CLINICAL MANIFESTATIONS

Some common bone marrow and blood cancer symptoms include:

● Fatigue: This is feeling so tired you can’t manage your daily activities. You may also feel weak.
● Persistent fever: A fever is a sign your body is fighting infection or responding to abnormal cancer cells.
● Drenching night sweats: This is sweating that comes on suddenly while you’re sleeping, disturbing your
sleep and drenching your bedding and clothes.
● Unusual bleeding or bruising: Everyone has bumps, bruises and injuries that make us bleed. Unusual
bleeding or bruising is bleeding that doesn’t stop and bruises that don’t heal after two weeks.
● Unexpected or unexplained weight loss: Unexpected weight loss of 10 pounds over a six- to 12-month
period is considered unexplained weight loss.
● Frequent infections: Frequent infections may be a sign something is affecting your immune system.
● Swollen lymph nodes or an enlarged liver or spleen: These symptoms may be signs of leukemia or
lymphoma.
● Bone pain: Myeloma and leukemia may cause bone pain or tender spots on your bones.
 ● Fever, chills
● Persistent weakness
● Loss of appetite, nausea
● Abdominal discomfort
● Headaches
● Shortness of breath
● Itchy skin or skin rash
● Swollen lymph nodes in the neck, underarms or groin
● Tiny red spots in your skin (petechiae)
● Bone tenderness
VIII. DIFFERENTIAL DX

Healthcare providers may begin diagnosis by asking about your symptoms and your medical history. They’ll do
complete physical examinations. They may order several kinds of blood and imaging tests, too. The tests they’ll use
may be different for each suspected blood cancer type. Tests used to diagnose blood cancer include:

● Complete blood count (CBC): This test measures and counts your blood cells. For example, if your healthcare
provider suspects you have leukemia, they’ll look for high (or low) white blood cell counts and lower than
normal red blood cell and platelet counts.
● Blood chemistry test: This test measures chemicals and other substances in your blood. In some cases, your
healthcare provider may order specific blood tests for cancer to learn more about your situation.
● Computed tomography (CT) scan: This test uses a series of X-rays and a computer to create three-
dimensional images of your soft tissues and bones. If your healthcare provider suspects you have myeloma,
they may order a CT scan to look for bone damage.
● Magnetic resonance imaging (MRI) scan: Your healthcare provider may order an MRI to look for signs of
leukemia or lymphoma complications affecting your spine.
● Positron emission tomography (PET) scan: This test produces images of your organs and tissues at work.
Your healthcare provider may order a PET scan to look for signs of myeloma.
● Bone marrow biopsies: Healthcare providers may do bone marrow biopsies to analyze the percentage of
normal and abnormal blood cells in your bone marrow. They may also test your bone marrow sample for
changes in your DNA that may drive cancer growth.
● Blood cell examination: Healthcare providers may take blood samples so they can examine them under a
microscope to look for changes in blood cell appearance. For example, they might order peripheral smear
test to look for signs of leukemia or lymphoma.
IX. MANAGEMENT

Blood cancer treatment isn’t one-size-fits-all. Some blood cancer types respond well to specific treatments. Some
blood cancer treatments have significant side effects. Healthcare providers consider factors, including your age, your
overall health, the kind of blood cancer you have and specific treatment side effects, before recommending a
treatment plan. Some common treatments for blood cancer include:

● Chemotherapy: Chemotherapy is a primary blood cancer treatment, killing cancer cells to either slow down
the disease's progress or eliminate the cancer. Healthcare providers use different drug types for different
blood cancers.
● Radiation therapy: Healthcare providers may use radiation to treat leukemia, lymphoma or myeloma.
Radiation targets abnormal cells, damaging their DNA so they can’t reproduce. Healthcare providers often
 combine radiation therapy with other treatments. They may use radiation to ease some symptoms.
● Immunotherapy: This treatment uses your immune system to fight cancer. Immunotherapy may help your
body make more immune cells or help your existing immune cells find and kill cancer cells.
● Targeted therapy for cancer: This cancer treatment targets genetic changes or mutations that turn healthy
cells into abnormal cells.
● CAR T-cell therapy: In CAR T-cell therapy, healthcare providers turn T-cell lymphocytes — a type of white
blood cell — into more effective cancer treatment. Healthcare providers may use CAR T-cell therapy to treat
B-cell acute lymphoblastic leukemia, multiple myeloma and several types of non-Hodgkin’s lymphoma if
other treatments haven’t worked.
● Autologous stem cell transplant: Healthcare providers can collect and store bone marrow stem cells before
administering high doses of chemotherapy. Once chemotherapy is done, they’ll replace the protected stem
cells. This way, people having autologous stem cell implants can avoid chemotherapy side effects.
● Allogeneic stem cell transplant: Sometimes, damaged bone marrow needs to be replaced with healthy bone
marrow. Healthcare providers identify a suitable bone marrow donor and use the donor’s cells to replace
your damaged ones. This is an effective but dangerous procedure.

Common Side Effects Of Blood Cancer Treatment

Blood cancer treatment often combines chemotherapy and radiation therapy. Both treatments are effective but
have different side effects. If you’re receiving chemotherapy or radiation therapy, ask your healthcare provider
about side effects. Here is information about other potential treatment side effects:

● CAR T-cell therapy side effects: The two most common CAR T-cell therapy side effects are cytokine release
syndrome (CRS) and neurological problems. If you have this syndrome, you may feel as if you have a bad
case of flu. CAR T-cell therapy can affect your nervous system, causing symptoms like balance problems,
seizures or tremors that may affect your daily activities. If you’re planning on CAR T-cell therapy, ask your
healthcare provider about side effects and ways to manage them.
● Immunotherapy side effects: About 50% of people who have immunotherapy have side effects. Fewer than
5% of people have serious side effects. Common side effects include skin rashes, fatigue, diarrhea and a drop
in thyroid levels.
● Targeted therapy side effects: Common side effects include diarrhea, elevated liver enzymes and rash. Long-
term use may increase the risk of heart problems and stroke.
● Stem cell transplantation side effects: There are different stem cell transplant types with different
complications and side effects. Potential complications will vary based on your overall health, age and
previous treatment. If you’re considering a stem cell transplant, your healthcare provider will outline
potential complications so you can weigh those risks against potential benefits.

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https://my.clevelandclinic.org/health/diseases/22883-blood-cancer