Download - Leukemia
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LEUKEMIAFAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG
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What Is Leukemia?Cancer of the white blood cellsAcute or ChronicAffects ability to produce normal blood cellsBone marrow makes abnormally large number of immature white blood cells called blasts
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Classification of leukemiasAcuteChronicMyeloid originLymphoid originAcute Myeloid Leukemia (AML)Acute Lymphoblastic Leukemia (ALL)Chronic Myeloid Leukemia (CML)Chronic Lymphocytic Leukemia (CLL)
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HematopoiesisPLURIPOTENTSTEM CELLCOMMITTEDPROGENITORCELLRECOGNIZABLE BONE MARROW PRECURSOR CELLMATURE BLOOD CELLmyeloblastmonoblastpronormoblastred cellneutrophilmonocytebasophilplateleteosinophilpre-Tpre-BmyeloidprogenitorcelllymphoidprogenitorcelllymphoblastlymphoblastT-cellB-cell& plasma cellMIXED PROGENITOR CELLCFU-Megmegakaryocytepluripotentstem cell
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Myeloid maturationMATURATIONAdapted and modified from U Va website
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Acute Leukemiaaccumulation of blasts in the marrow
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How to distinguish AML vs CMLfrom looking at peripheral bloodMyeloid cell CML AML normalblasts q qpromyelocytes qmyelocytes qmetamyelocytes qbands qneutrophils q# q
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Classification of acute leukemiasALLmainly childrenM > Fcurable in 70% of childrencurable in minority of adultsAMLmainly adultsM > F
curable in minority of adults
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Clinical manifestationssymptoms due to:marrow failuretissue infiltrationleukostasisconstitutional symptoms
usually short duration of symptoms
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Marrow failureNeutropenia : infections, sepsisAnemia : fatigue, pallorThrombocytopenia : bleeding
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Infiltration of tissues/organsEnlargement of liver, spleen, lymph nodesGum hypertrophyBone painOther organs: CNS, skin, testis, any organ
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Gum hypertrophy
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LeukostasisAccumulation of blasts in microcirculation with impaired perfusion Lungs: hypoxemia, pulmonary infiltratesCNS: strokeOnly seen with WBC >> 50 x 109/L
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Causes of acute leukemiasIdiopathic (most)Underlying hematologic disordersChemicals, drugsRadiationViruses Hereditary/genetic conditions
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Constitutional symptomsFever and sweats commonWeight loss less common
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Laboratory featuresWBC usually elevated, but can be normal or lowBlasts in peripheral bloodNormocytic anemiaThrombocytopenia
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Bone marrow in acute leukemiaNecessary for diagnosisUseful for determining typeUseful for prognosisAcute leukemias are defined by the presence of > 20% blasts in bone marrow (% of nucleated marrow cells)
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Distinguishing AML from ALLLight microscopyAML: Auer rods, cytoplasmic granulesALL: no Auer rods or granules.Special stains (cytochemistry)Flow cytometry
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AML
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ALL
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Auer rods in AML
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Treatment of acute leukemiasChoice of Rx is influenced by:type (AML vs ALL)agecurative vs palliative intentChemotherapyImmunotherapyRadiationBone marrow transplant
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Principles of treatmentCombination chemotherapyfirst goal is complete remissionfurther Rx to prevent relapseSupportive medical caretransfusions, antibiotics, nutritionPsychosocial supportpatient and family
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SEMOGA BERMANFAAT.
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