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Leukemia: Acute Leukemia – White Blood Cell Pathology

by Carlo Raj, MD
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    00:00 Here we’ll take a look at leukemia.

    00:02 It’s a topic that most med students are quite afraid of.

    00:05 But not to worry.

    00:06 We will go through this together.

    00:08 And by the time we’re done, your thoughts will be extremely organized and you’ll be able to identify your patient very, very confidently.

    00:14 Let’s take a look.

    00:17 Acute.

    00:18 What does acute mean to you? It means fast.

    00:22 What does leukemia mean to you? It means cancer.

    00:25 Okay.

    00:26 A cancer developing from where? Bone marrow.

    00:30 That’s where your focus will be initially.

    00:33 However at some point in time, you do know that on your peripheral blood smear you are then going to find an increased number of cells.

    00:40 That puts this into leukemia.

    00:42 And there is every possibility with the leukemia that these cells might then enter a lymph node.

    00:47 And therefore the presentation here might be very much like a lymphoma and that will tell you as to when that will be relevant to you for symptoms and signs as far as the patient is concerned.

    00:58 Is it neoplastic leukocytic origin? If you found predominance of immature cells, which are then called blasts, Where? Bone, bone, bone, bone, bone marrow.

    01:10 B as in blasts.

    01:12 B in bone marrow.

    01:14 What is acute? What does this mean? Since this is a leukocytic type of neoplasm that the cell within the bone marrow is not being matured quick enough.

    01:25 In fact, many of your cells of the neoplasm remain in its blastic form, which is a very primitive and very young cell.

    01:37 By definition, ALL or AML which are both acute leukemias, by definition, you have to find greater than 20% blasts in the bone marrow.

    01:49 Once that’s understood, it’s only then we can move on.

    01:53 Symptoms due to marrow failure is exactly what you would expect secondary to leukemia.

    02:00 Now, even though, you might find increased number of cells within the bone marrow and maybe and we would, in the peripheral blood smear.

    02:09 So now we have 2 different compartments.

    02:12 These cells that you’re producing are not working properly.

    02:16 Not only would you have problems with one type of cell but many others.

    02:20 Therefore, you can expect there would be pancytopenia with acute leukemias.

    02:24 Meaning to say that you have leukopenia, anemia and you have thrombocytopenia.

    02:29 Usually the first symptom that the patient is exhibiting would be signs and symptoms of anemia.

    02:34 Meaning to say fatigue and tiredness.

    02:36 The one that you’re worried about very much in terms of pancytopenia would be the susceptibility to infections, leukopenia.

    02:44 Definition of acute leukemias referring to both AML or ALL, greater than 20% blasts in the bone marrow.

    02:54 Etiology, chromosomal abnormalities are a possibility and Down syndrome is something we’ll take a look at.

    03:01 We’ll take a look at ALL, ionizing radiation.

    03:04 We have chemical exposure or maybe even perhaps alkylating agent.

    03:08 Wait, hold down for a second.

    03:10 You should be asking yourself what does this mean? The patient was receiving chemotherapy for another type of cancer.

    03:16 And while receiving the chemotherapy unfortunately develops another type of leukemia.

    03:21 So even alkylating agents that are being used to prior cancers might then unfortunately give rise to a new leukemias.

    03:28 Age.

    03:32 Subtypes: There will AML/ALL.

    03:35 Next, what you want to do with acute leukemias? So far, you have a definition of leukemias.

    03:40 This is a neoplasm of your leukocytic origin from the bone marrow.

    03:48 We have greater than 20% blasts from the bone marrow.

    03:51 And now, we’ll take a look at the various lineages of your cell or your bone marrow, the 2 major lineages.

    03:58 One lineage will be myeloid.

    04:00 The other lineage will be lymphoid.

    04:03 If you’re thinking myeloid, it’s all cells except your T-cells, B-cells and natural killer cells.

    04:10 So when you say acute myelogenous leukemia, you know that you’re dealing with many different types of myeloid cells.

    04:17 Hence, you will be using what’s known as FAB classification, M0 all way out to M7.

    04:26 By the time we come to M3 you’ve heard of, well, this is promyelocyte.

    04:30 Hence, M3, which we will be focusing upon, is called your acute promyelocytic leukemia or promyelocytic leukemia.

    04:39 Do not forget the other name.

    04:41 By the time you’re still getting to M5, you’re producing more monocytic.

    04:44 By the time you’re still getting to M5 to M6 and such, more RBC’s and M7 will be megakaryocytes.

    04:51 All myeloid, all myeloid.

    04:54 Disease of immature granulocytes.

    04:57 Seen in, well basically, all age ranges.

    04:59 Look at this, 15-60, so the age is not going to tell you much.

    05:05 Tell me what you’re going to find in your bone marrow? Greater than 20% blasts in your bone marrow.

    05:10 And if you’re thinking myeloid, you’re affecting all the myeloid cells except T-cells and B-cells.

    05:15 What’s the other type of acute leukemia? It’s acute lymphoblastic leukemia, would be the better name that you need to know.

    05:22 Once again why do we call this lymphoblastic? Because you will find greater than 20% blasts in the bone marrow.

    05:28 Since we’re dealing with ALL, lympho-.

    05:31 There’s only 2 types of ALL, T type and B type, B type/T type, T type/B type.

    05:38 If it’s AML, there is 7 different subtypes because there are 7 different methods of developing other myeloid cells.

    05:45 Clear? Next.

    05:47 Disease of immature lymphocyte, pre-B or pre-T ALLs.

    05:52 Typically, now you know that this is the youngest leukemia causing cancer.

    05:57 So in this, you’re thinking about age group of, well, less than 15 years of age.

    06:02 Number 1 leukemia in this age group.


    About the Lecture

    The lecture Leukemia: Acute Leukemia – White Blood Cell Pathology by Carlo Raj, MD is from the course Leukemia – White Blood Cell Pathology (WBC).


    Included Quiz Questions

    1. Greater than 20%
    2. Greater than 5%
    3. Greater than 15%
    4. Greater than 18%
    5. Less than 15%
    1. clock-face plasma cells
    2. Thrombocytopenia
    3. leukopenia
    4. Anemia
    5. Pancytopenia
    1. 7
    2. 8
    3. 5
    4. 4
    5. 6
    1. 0-15 years
    2. 20-30 years
    3. 13-20 years
    4. 40—50 years
    5. 20-35 years

    Author of lecture Leukemia: Acute Leukemia – White Blood Cell Pathology

     Carlo Raj, MD

    Carlo Raj, MD


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    best video
    By asha p. on 29. August 2017 for Leukemia: Acute Leukemia – White Blood Cell Pathology

    I liked this video because this one is short and informative