LEUKEMIA

1
LEUKEMIA
DR. AYESHA JUNAID MBBS,MCPS,FCPS. Professor of
Pathology Consultant Haematology Incharge Blood
Transfusion Services-SIH
2
Leukemia

• OBJECTIVES
• What is leukemia?
• What is the Pathogenesis of Leukeima?
• How do we classify leukemia?
• (WHO 2008 classification)

3
Leukemia

• OBJECTIVES
• What is their clinical presentation?
• How do we diagnose leukemia in laboratory?
• What are the basic principles of
• management?

4
Leukemia vs Leukemoid Reaction

• Leucocytosis
• Neutrophilia,Eosinophilia,Lymphocytes
• Leucopenia
• Leukemoid Reaction
• Leukemia

5
Leukemia

• Myeloid cells
• Mitotic pool (blast to myelocytes)
• Maturation pool (ends with the mature neutrophil)
• Storage pool (Mature neutrophils residing in the
  bone marrow)

6
LEUKEMIA

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

7
LEUKEMIA

• It results from the mutation in a single stem
  cell
• The progeny of which form a clone of leukemic
  cells

8
LEUKEMIA

• Genetic events contributing to malignant
  transformation include
• Inappropriate expression of oncogenes
• Loss of function of TSG

9
LEUKEMIA CLASSIFICATION

• LINEAGE DEGREE OF MATURATION
• MORPHOLOGY
• CYTOCHEMICAL
• CYTOGENETICS
• IMMUNOPHENOTYPICAL
• IMMUNOHISTOCHEMISTRY
• MOLECULAR GENETICS

10
LEUKEMIA CLASSIFICATION

• WHO 2008
• Evidence based classification for daily
  therapeutic decisions.
• Provides a flexible framework for integration of
  new data

11
LEUKEMIA

• Acute leukemia
• Chronic leukemia
• Acute Myeloid Leukemia
• Acute Lymphoid Leukemia
• Chronic Myeloid Leukemia
• Chronic Lymphoid Leukemia

12
ACUTE LEUKEMIA

• Heterogeneous group of clonal disorders arising
  from
• Pluripotent stem cells
• Clinical course
• Response to therapy

13
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

14
BONE MARROW TREPHINE HIGH AND LOW POWER
15
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

16
Leukemia
17
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

18
CYTOCHEMISTRY
19
CYTOCHEMISTRY
PAS
20
ACUTE LEUKEMIA
AML
ALL
21
ACUTE LEUKEMIA

• CLINICAL FEATURES
• ONSET
• Abrupt, acute
• Insidious, slowly progressive
• Bone marrow malfunction
• Anemia, infection bleeding

22
ACUTE LYMPHOBLASTIC LEUKEMIA

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

23
LEUKEMIA

• LABORATORY EVALUATION
• Anemia
• Leukocytosis/leukopenia/normal TLC
• Thrombocytopenia
• Bone marrow examination
• Aspirate biopsy

24
LABORATORY EVALUATION
25
(No Transcript)
26
LEUKEMIA