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Acute Leukaemias

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Acute Leukaemias Powered By Docstoc
					          The leukaemias
 Abnormal proliferation of haemopoietic
  cells
 Causes progressively increasing
  infiltration of bone marrow or lymphatic
  tissues.
                     Aetiology
 Leukaemic cell population can have one or more
  different pathways of differentiation.
 Critical step is is the alteration of the structure of of
  DNA in the nucleus.
 In humans chromosomal abnormalities are very
  common in leukaemias.
 Associated aetiological factors are
       Radiation
       Chemicals
       Viruses
       Genetic factors
        Classification of leukaemia
        Acute               Chronic
   Agressive clinical       Chronic clinical course
    course
                             Dominant cell is more
   Dominant cell is an       mature
    immature blast cell

   Classified to            Classified to lymphatic
    lymphoblastic and         and myeloid
    myeloblasti
Acute leukaemias
            FAB classification
         L1: small round blast
         L2: pleomorphic large
             blasts
         L3: very large blasts with
             vacoalated
         cytoplasm
        Acute Myeloid Leukaemia
   FAB classification
    M1-no differentiation
    M2-minimal
    differentiation
    M3-promyelocytic
    M4-myelomonocytic
    M5-monocytic
    M6-erythroid
    M7-megakaryocytic
           Clinical features
 Occur at any age
 Onset Abrupt
 Common :       Anaemia
                 Fever malaise
                 Haemorhage
 Clinical features are often due to:
1.Bone marrow infiltration due to blast cell
  proliferation causing
  Anaemia: Pallor, tiredness
  Thrombocytopenia: gum bleeding, purpura
  Neutropenia: Infections, fever, pharyngitis
2.Organomegaly: ALL-lymphadenopathy
                  AML-hepato/splenomegaly
                        Gum hypertrophy-M4
3.Bone pain/joint pain
    Laboratory investigations
 Full blood count:
  WBC: increased
  DC: neutropenia
       blast cells
  Platelet count: low
  Red cell count: low
  Hb:low
 Blood picture
         Bone marrow biopsy
   Hypercellular
    fragments
   Erythropoiesis: 
   Granulopoiesis: 
   Megakaryocytes: 
   Blast cells more
    than 30%
Differential diagnosis: clinically
 Other causes of ulceration of mouth
 Infectious mononucleosis:
      sore throat
      lymphadenopathy
      splenomegaly

 Joint and bone pain:
     Acute osteomyelitis
     Rheumatic fever
Fever and malaise
     Similar blood pictures
 Leukaemoid blood picture
 Pancytopenia
 Myelodysplastic syndromes
             Treatment
 General considerations
 Specific therapeutic agents
 Therapy in individual patients
 Symptomatic and supportive therapy
 Bone marrow transplantation
Specific therapeutic agents in
             ALL
 Remission Induction
 Consolidation
 Prophylactic treatment
 Maintainance therapy
 AML
 Remission induction
 Maintainance therapy

				
DOCUMENT INFO
Description: Common haematological conditions