LEUKEMIA

DR. AYESHA JUNAIDMBBS,MCPS,FCPS.Professor of PathologyConsultant HaematologyIncharge Blood Transfusion Services-SIH

Leukemia

OBJECTIVES

What is leukemia?What is the Pathogenesis of

Leukeima?How do we classify leukemia? (WHO 2008 classification)

Leukemia

OBJECTIVES

What is their clinical presentation?How do we diagnose leukemia in

laboratory?What are the basic principles of management?

Leukemia vs Leukemoid Reaction

Leucocytosis Neutrophilia,Eosinophilia,Lympho

cytes Leucopenia Leukemoid Reaction Leukemia

Leukemia

Myeloid cells Mitotic pool (blast to myelocytes) Maturation pool (ends with the

mature neutrophil) Storage pool (Mature neutrophils

residing in the bone marrow)

LEUKEMIA

Leukemia is a disease resulting from the neoplastic proliferation of hemopoeitic or lymphoid cells

LEUKEMIA

It results from the mutation in a single stem cell

The progeny of which form a clone of leukemic cells

LEUKEMIA

Genetic events contributing to malignant transformation include

Inappropriate expression of oncogenes

Loss of function of TSG

LEUKEMIA CLASSIFICATION

LINEAGE & DEGREE OF MATURATION

MORPHOLOGYCYTOCHEMICALCYTOGENETICSIMMUNOPHENOTYPICALIMMUNOHISTOCHEMISTRYMOLECULAR GENETICS

LEUKEMIA CLASSIFICATION

WHO 2008 Evidence based classification for daily

therapeutic decisions.

Provides a flexible framework for integration of new data

LEUKEMIA

Acute leukemia Chronic leukemia

Acute Myeloid Leukemia Acute Lymphoid Leukemia Chronic Myeloid Leukemia Chronic Lymphoid Leukemia

ACUTE LEUKEMIA

Heterogeneous group of clonal disorders arising from

• Pluripotent stem cells• Clinical course• Response to therapy

ACUTE LEUKEMIA

Acute leukemia accounts for approximately 10% of all human cancers

Is the leading cause of cancer deaths in adults younger than 35 years of age

BONE MARROW TREPHINE HIGH AND LOW POWER

CYTOCHEMISTRY It identifies diagnostically useful enzymes

or other cytoplasmic substances of hemopoietic cells

Particularly useful for identification of immature cells in leukemia

SUDAN BLACK B PERIODIC ACID SCHIFF(PAS) ACID PHOSPHATASE

Leukemia

AML/ALL MORPHOLOGY Differentiation on morphological grounds

alone is not possible

Morphological features favoring lymphoid derivation include

Blasts including relatively condensed chromatin

Absence of conspicuous nucleoli Presence of scanty agranular cytoplasm

CYTOCHEMISTRY

CYTOCHEMISTRY

PAS

ACUTE LEUKEMIAAMLALL

ACUTE LEUKEMIA

CLINICAL FEATURESONSET Abrupt, acute Insidious, slowly progressive Bone marrow malfunction Anemia, infection & bleeding

ACUTE LYMPHOBLASTIC LEUKEMIA

CLINICAL FEATURES Bone pain & tenderness Lymphadenopathy Splenomegaly Hepatomegally CNS manifestations Testicular involvement Skin

LEUKEMIA

LABORATORY EVALUATION

Anemia Leukocytosis/leukopenia/normal

TLC Thrombocytopenia Bone marrow examination Aspirate & biopsy

LABORATORY EVALUATION

LEUKEMIA