Acute Leukemia

Neoplastic proliferation of blasts

•

blasts
•

Defined as the accumulation

of > 20% in Bone

marrow .

Blast cells
•

usually enter the

blood stream ,
resulting in a

count
high KIBC .

immature cells
( Blasts large ,
.

often with punched out nucleus)

Acute leukemia is
classified in
•

(a) Acute
lymphoblastic leukemia ( ALL )

(b) Acute Leukemia (

myelogenous
AML )

Acute Lymphoblastic Leukemia

•
Acute lymphoblastic leukemia / lymphomas are
neoplasm
composed of immature B ( pre B) or T
( pre -
T ) cells ,

which are
referred as
lymphoblasts .

Neoplastic accumulation of lymphoblasts ( > 20%1 in

bone marrow .

Most children associated

commonly
• arises in with

Down Syndrome .
 Sub
classified into B- All based
°

& T - ALL on

surface markers .

•
B- All is the most common .

characterised
Usually by lymphoblast
( Td T
-1
) that express CD to ,
CD 19 & CD 20 .

T characterized
ALL is
by
•
-

lymphoblasts ( Tdt -1 ) that express

markers
from CD 2 to CDs .

Clinical Features :

disease and most

•
All is an
aggressive ,
patients
present within a
few weeks
of the onset
of symptoms .

•
Most
important signs &
symptoms are :

ii ,
symptoms related to depression of marrow
function
-

Fatigue from Anemia

- Fever

due to
-

Bleeding thrombocytopenia .

iii , Mass
effects caused
by Neoplastic infiltration ,

Bone
pain
-

Generalised lymphadenopathy
-

Splenomegaly
Hepatomegaly
-

.
 Central Nervous
Ciii, System manifestations resulting
from meningeal spread , such as headache ,

vomiting & nerve

palsies .

Acute Myeloid Leukemia

•

Neoplastic accumulation
of Immature

myeloid cells ( > 20% ) in Bone marrow .

Myelo blasts are

usually
characterised by positive
cytoplasmic staining for
My elo peroxidase ( MPO )

•
Most
commonly arise in Older Adults ( avg.ge 50-60 )
years
Pathogenesis :

Most harbor mutations

encoding
Amis in
genes
•

transcription factors that are

required for normal

myeloid cell differentiation .

Subclassification based on
cytogenetic abnormalities

immature myeloid
lineage of cells &
surface
markers .
 High Yield
subtypes include
•

:
-

Acute leukemia
( is
promyelocylic ( API ) •

Ii , Acute
monocyte leukemia
Iii , Acute
megakaryoblaslic leukemia .

•
AML
may
also rise
from pre
-

existing dysplasia
( Myelodysplastic syndromes ) ,

Esp .

prior
to
Alkylating agents or
Radiotherapy .

Clinical Features :

Findings are
very
similar to those of All

Myelodysplastic syndrome presents

'
•
-

Cytopenias
-

Hyper cellular Bone marrow

Abnormal maturation cells

-

of
-

Inc . blasts (> 20% )

C
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