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LEUKEMIA

LEUKEMIA. DR. AYESHA JUNAID MBBS,MCPS,FCPS. Professor of Pathology Consultant Haematology Incharge Blood Transfusion Services-SIH. Leukemia. OBJECTIVES What is leukemia? What is the Pathogenesis of Leukeima? How do we classify leukemia? ( WHO 2008 classification).

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LEUKEMIA

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  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 lymphoidcells

  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 ALL AML

  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. LEUKEMIA

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