Description
This lecture on Acute Leukaemias provides essential notes for Medical Licentiates and other tertiary-level health sciences students. It offers a comprehensive overview of acute leukaemias, detailing their classification into Acute Lymphocytic Leukaemia, Acute Myeloid Leukaemia, and other subtypes. The material systematically covers the epidemiology, etiology, and key clinical features including systemic effects, bone marrow invasion, and CNS involvement. It outlines the diagnostic process, from clinical manifestations and blood counts to bone marrow examination and classification systems like the FAB classification for ALL and AML. The notes also review treatment principles, encompassing both supportive medical care and specific therapy aims such as inducing remission and CNS prophylaxis. This structured resource serves as valuable revision material for students in certificate, diploma, or degree programmes in clinical medicine, nursing, and medical laboratory science, supporting their preparation for examinations and practical understanding of haematological malignancies. Download these detailed notes to strengthen your grasp of this critical topic in pathology.
What's inside
ACUTE LEUKAEMIAS Medical Licentiates Lecture Acute Leukaemia Introduction - Blastic transformation of cells of haematologic origin representing a clonal expansion and arrest at a specific stage of normal myeloid or lymphoid hematopoiesis - Blast cells may express both myeloid and lymphoid features - Constitute 97% of all childhood leaukaemias Types 1. Acute Lymphocytic leukaemia 2. Acute myeloid leukaemia 3. Acute undifferentiated leukaemia 4. Acute mixed lineage leukaemia a. Acute lymphoblastic leukaemia expressing ≥ 2 myeloid associated antigens MY+ ALL b. Acute myeloid leukaemia expressing ≥ 2 lymphoid associated antigens LY+ AML Epidemiology Incidence Peak incidence between 2 and 5 years of age Accounts for 25-30% of childhood cancers world wide Etiology Unknown Important pathogenetic factors include 1. Ionizing radiation 2. Chemicals eg benzene, heavy metals 3. Drugs eg alkylating agents 4. Genetic considerations a. 20% risk of leukaemia in other twin if identical twin develops disease b. 4 times greater incidence of leukaemia in siblings of patient compared to general population c. Chromasomal abnormalities eg Down syndrome, Fanconi’s d. Genetic conditions Clinical Features General systemic effects Extramedullary invasion Fever (60%) signs of infections Pallor (40%) 3. Signs of bleeding CNS involvement 1. Signs and sympyoms of raised ICP 2. Signs and symptoms of parenchymal involvement a. focal neurologic involvement b. cerebellar involvement 3. Hypothalamic syndrome - polyphagia with weight gain, hirsutism, behavioral disturbances 4. Diabetes insipidus 5. Chloromas 6. CNS haemorrhage Bone marrow invasion 1. Anaemia 2. Neutropenia/neutrophilia -blasts 3. Thrombocytopenia GUT - testicular enlargement, ovarian, priapism, renal, Bone and Joint - Bone pain, Radiologic changes Skin infiltration Cardiac involvement - Myocardial infiltrate and haemorrhage Other organ involvement Lymphoid tissue invasion 1. Lymphadenopathy 2. Splenomegaly 3. Hepatomegaly DIC Gum hypertrophy Diagnosis Clinical Manifestations Chest radiograph Mediastinal mass in T-cell leukaemia Blood count a. Reduced Hb b. WBC - low, normal or Increased c. Thrombocytopenia d. Blood smear - blasts few to none Chemistry and cells Skeletal survey Bone marrow Required for diagnosis > 5% blasts for diagnosis Usually 80-100% blasts Megakaryocytes absent Blood chemistry Cerebral spinal fluid Coagulation profile Cardiac function Infectious disease profile Classification Morphology Cytochemical features FAB classification for ALL L1, L2, L3 FAB classification for AML M0, M1, M2, M3, M3V, M4, M4EOS, M5, M6, M7 Cytogenetics and Molecular characteristics Immunological Treatment Supportive psychologic care Supportive medical care 1. Blood component therapy 2. Infectious complications 3. Pain management 4. Management of Nausea and Vomiting 5. Nutritional support 6. Haematopoietic growth factor support Specific therapy Aims of therapy 1. Induce clinical and hematological remission 2. Maintain remission by systemic chemotherapy and CNS prophylaxis 3. Treat complications of therapy and of disease
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