Clinical Hematology II

HML2143

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 LO5: Describe the classification and investigation of the
hematological malignancies of the acute leukemia’s, chronic
myeloproliferative neoplasms and myelodysplastic syndromes
according to WHO classifications.

Week 9:

• Describe the aetiology, classification,pathophysiology, diagnosis and

treatment of the acute leukemias to include (ALL), (APML),(AMML)
and (AML).

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Content

Introduction To Leukaemias
 Definition

• Leukaemia is “an interruption in the differentiation

of one or more bone marrow cell lines with a
subsequent increase in the proliferation of the
abnormal cells which are usually to be found in the
peripheral blood”.

• Differentiation is abnormal.
• Proliferation of the abnormal cells takes place.

• Leukaemia is a malignancy or neoplasm of the bone

marrow hemopoietic cells.
 Aetiology

• There is very little absolute proof of what may cause leukaemia.

• However the following factors have been linked with the development
of leukaemia.

1. Ionising Radiation:
a) Medical e.g. radiation given as therapy.
b) Nuclear e.g. atom bomb dropped on Hiroshima and
Nagasaki during the Second World War.
c) Environmental e.g. radon gas emitted from some types of
rock.
2. Chemicals/ drugs:
a) Benzene.
b) Alkylating agents (drugs used to treat leukaemia).
 Aetiology
3. Viruses
• EBV “Epstein-Barr Virus” (e.g. Burkitt’s lymphoma in Africa) 
possibly in combination with another factor (malaria?).
• HTLV (Human T-cell Lymphotropic Viruses) Group of
retroviruses associated with leukemia and lymphomas
•
4. Genetic/ chromosomal abnormalities
• Trisomy 21 Acute lymphoblastic leukaemia (ALL).
• Philadelphia Chromosome (Ph1) Chronic myeloid leukaemia
(CML)
• Low incidence of Chronic Lymphocytic Leukaemia (CLL) in the
Japanese population.
 Classification

• Leukemias are classified on the basis of:

1. Cell type Acute {blasts} OR Chronic for more mature cells {-cytes}.
2.
3. Cell lineage Myeloid OR Lymphoid
4.
5. Historical prognosis (how long the patients lived without treatment).
a. If patients died within a few days or weeks disease was called ‘acute’.
b. If patients lived for several months or years, disease was called ‘chronic’.
• This is not strictly true nowadays because each leukaemia can be treated &
patients survive for much longer.
a.
 Classification

However, terms ‘acute’ & ‘chronic’ are still used, but they are now applied to the
cell morphology.

1) Acute:
• Very primitive. Blast cells present (little or no differentiation)
•
2) Chronic
• More mature cells present.
• These may appear normal
•
•
 References
• Kaushansky/ et al, (2016) Williams Hematology, 9th Ed. McGraw-Hill. ISBN 9780071833011
•
• Lewis, S., Bain, B., Bates, I. (2012) Dacie and Lewis, Practical Haematology, 11th Ed., Churchill Livingstone
Elsevier. ISBN: 978-0-7020-3407-7
•
• Hoffbrand, A., Moss, P. (2011) Essential Haematology, 6th Ed. Wiley Blackwell. ISBN: 978-1-4051-9890-5

• Moss, Paul, Pettit, Hoffbrand. Essential Haematology, 5th Ed. Blackwell Science. 2006. ISBN:
9781405136495
•
• Moore, Gary/ Knight, Gavin (2013) Essential Haematology, Oxford University Press ISBN: 9780191666711

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