Week 12: Malignant Leukocyte Disorders - PDF

MALIGNANT 12 LEUKOCYTE DISORDERS LEUKEMIA Virchow was the first to recognize leukemia as a distinct clinical disorder between 1839 and 1845. He named this disorder leukemia because of the white appearance of the blood from patients with fever, weakness, and lymphadenopathy LEUKEMIA...

MALIGNANT 12 LEUKOCYTE DISORDERS LEUKEMIA Virchow was the first to recognize leukemia as a distinct clinical disorder between 1839 and 1845. He named this disorder leukemia because of the white appearance of the blood from patients with fever, weakness, and lymphadenopathy LEUKEMIA Abnormal, uncontrolled proliferation and accumulation of one or more of the hematopoietic cells SYMPTOMS OF LEUKEMIA Fatigue and Weakness Increased Infections Bleeding and Bruising Anemia Swollen Lymph Nodes Enlarged Spleen or Liver Bone Pain or Tenderness LEUKEMIA A disease, usually of leukocytes, in the blood and bone marrow. Overproduction of various types of immature or mature leukocytes in the bone marrow and/ or peripheral blood LYMPHOMA General term for malignancy that starts in the lymph system, mainly the lymph nodes. Two main types of lymphomas are Hodgkin lymphoma and non-Hodgkin lymphoma MYELOMA A form of cancer of the plasma cells. In myeloma, the cells overgrow, forming a mass or tumor that is located in the bone marrow.  Feature leukemia Lymphoma Myeloma Target White Blood Cells Plasma Cells (Mature Cell (Lymphocytes or Lymphocytes Lymphocytes) Myelocytes) Crowds out healthy Growth cells in bone Forms tumors in Forms tumors in Pattern marrow, Spreads to lymphatic system bone marrow blood and organs Fatigue, Fever, Swollen Lymph Bone Pain, Fatigue, Symptoms Infections, Bleeding, Nodes, Fever, Night Infections, Weakness, Weight Loss Sweats, Weight Loss Kidney Problems CLASSIFICATION 1. DURATION a. Acute leukemia = days to 6 months b. Subacute leukemia = 2 to 6 months c. Chronic leukemia = 1 or 2 years or more 2. NUMBER OF WHITE BLOOD CELLS PRESENT IN PBS Leukemia wbc count Immature cells acute 30 % blast in the peripheral blood and bone marrow. SUBDIVIDE LEUKEMIA ACCORDING TO: Cellular morphology Cytochemical staining results. 2. WORLD HEALTH ORGANIZATION Widely used to classify leukemia. It is now the standard classification in diagnosing leukemia defines acute leukemia as >20% peripheral blood and bone marrow blasts SUBDIVIDE LEUKEMIA ACCORDING TO: Cellular morphology Cytochemical stains(cytochemistry) Immunophenotyping (Flow cytometry) Cytogenetic abnormalities Clinical syndrome. CYTOGENETIC (KARYOTYPING)ANALYSIS Devoted to the laboratory study of visible chromosome abnormalities, such as deletions, translocations, and aneuploidy. identify any abnormalities in the number or structure of chromosomes. This might include missing pieces, extra copies, translocations (swapping of genetic material), inversions (reversed order of genes), or deletions. CYTOCHEMISTRY Use of specialized stains to detect cellular enzymes and other chemicals in peripheral blood films and bone marrow aspirate smears. Used to differentiate hematologic diseases, especially leukemias. IMMUNOPHENOTYPING (FLOW CYTOMETRY) Used to identify cells on the basis of the types of markers or antigens present on the cell's surface, nucleus, or cytoplasm. This technique helps identify the lineage of cells using antibodies that detect markers or antigens on the cells Synthetic antibodies, often monoclonal antibodies produced by hybridoma technology, are used to identify the antigens or CD markers by flow cytometry ACUTE LYMPHOBLASTIC LEUKEMIA (FAB CLASSIFICATION) 1. ALL L1 lymphoblasts are small and homogenous, varies little in size Scanty cytoplasm and inconspicuous nucleoli nucleus is round and irregular/indistinct in shape have high N:C ratio most common CHILDHOOD ALL with best prognosis 2. ALL L2 Lymphoblasts are large and heterogenous, variable in size abundant, basophilic cytoplasm, and the nuclei are often clefted with nucleoli present Adult type ALL 3. ALL L3 Burkitt-Type Lymphoblasts are large, homogenous and vacuolated rarest subclass, can be found in both children and adult poor prognosis ACUTE MYELOID LEUKEMIA (FAB CLASSIFICATION) MO: ACUTE MYELOID LEUKEMIA, MINIMALLY DIFFERENTIATED M1: ACUTE MYELOID LEUKEMIA WITHOUT MATURATION >30 % blast 30% blast >30% granulocytic cells M3: ACUTE PROMYELOCYTIC LEUKEMIA >30% blast >10% granulocytic cells 30% or >50 % promyelocytes M4: ACUTE MYELOMONOCYTIC LEUKEMIA 20 to 80% monoblast M5B: ACUTE MONOBLASTIC LEUKEMIA WITH MATURATION >80% monocytic cells