Here we’ll take a look at leukemia.
It’s a topic that most med
students are quite afraid of.
But not to worry.
We will go through this together.
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.
Let’s take a look.
What does acute mean to you?
It means fast.
What does leukemia mean to you?
It means cancer.
A cancer developing from where?
That’s where your focus
will be initially.
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.
That puts this into leukemia.
And there is every possibility
with the leukemia that
these cells might then
enter a lymph node.
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.
Is it neoplastic leukocytic origin?
If you found predominance of immature
cells, which are then called blasts,
Bone, bone, bone,
bone, bone marrow.
B as in blasts.
B in bone marrow.
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.
In fact, many of your cells of the
neoplasm remain in its blastic form,
which is a very primitive
and very young cell.
ALL or AML which are both acute leukemias,
by definition, you have to find greater
than 20% blasts in the bone marrow.
Once that’s understood, it’s
only then we can move on.
Symptoms due to marrow failure
is exactly what you would expect
secondary to leukemia.
Now, even though, you might find increased
number of cells within the bone marrow
and maybe and we would, in
the peripheral blood smear.
So now we have 2
These cells that you’re producing
are not working properly.
Not only would you have problems
with one type of cell but many others.
Therefore, you can expect there would
be pancytopenia with acute leukemias.
Meaning to say that you have leukopenia,
anemia and you have thrombocytopenia.
Usually the first symptom that
the patient is exhibiting
would be signs and
symptoms of anemia.
Meaning to say fatigue and tiredness.
The one that you’re worried about
very much in terms of pancytopenia
would be the susceptibility
Definition of acute leukemias
referring to both AML or ALL,
greater than 20% blasts
in the bone marrow.
abnormalities are a possibility
and Down syndrome is something
we’ll take a look at.
We’ll take a look at
ALL, ionizing radiation.
We have chemical exposure or maybe
even perhaps alkylating agent.
Wait, hold down for a second.
You should be asking yourself
what does this mean?
The patient was receiving chemotherapy
for another type of cancer.
And while receiving the chemotherapy
unfortunately develops another type of leukemia.
So even alkylating agents that
are being used to prior cancers
might then unfortunately
give rise to a new leukemias.
There will AML/ALL.
Next, what you want to
do with acute leukemias?
So far, you have a
definition of leukemias.
This is a neoplasm of your leukocytic
origin from the bone marrow.
We have greater than 20%
blasts from the bone marrow.
And now, we’ll take a look at the various
lineages of your cell or your bone marrow,
the 2 major lineages.
One lineage will be myeloid.
The other lineage will be lymphoid.
If you’re thinking myeloid, it’s all cells
except your T-cells, B-cells
and natural killer cells.
So when you say acute myelogenous leukemia,
you know that you’re dealing with many
different types of myeloid cells.
Hence, you will be using what’s
known as FAB classification,
M0 all way out to M7.
By the time we come to
M3 you’ve heard of,
well, this is promyelocyte.
Hence, M3, which we
will be focusing upon,
is called your acute promyelocytic
leukemia or promyelocytic leukemia.
Do not forget the other name.
By the time you’re still getting to
M5, you’re producing more monocytic.
By the time you’re still
getting to M5 to M6 and such,
more RBC’s and M7 will
All myeloid, all myeloid.
Disease of immature
Seen in, well basically, all age ranges.
Look at this, 15-60,
so the age is not going
to tell you much.
Tell me what you’re going to
find in your bone marrow?
Greater than 20% blasts
in your bone marrow.
And if you’re thinking myeloid,
you’re affecting all the myeloid
cells except T-cells and B-cells.
What’s the other type of acute leukemia?
It’s acute lymphoblastic leukemia, would
be the better name that you need to know.
Once again why do we
call this lymphoblastic?
Because you will find greater than
20% blasts in the bone marrow.
Since we’re dealing
with ALL, lympho-.
There’s only 2 types of ALL,
T type and B type,
B type/T type, T type/B type.
If it’s AML, there is
7 different subtypes
because there are 7 different methods
of developing other myeloid cells.
Disease of immature lymphocyte,
pre-B or pre-T ALLs.
Typically, now you know that this is
the youngest leukemia causing cancer.
So in this, you’re thinking about age
group of, well, less than 15 years of age.
Number 1 leukemia in this age group.