Leukemia: Acute Lymphocytic Leukemia (ALL) – White Blood Cell Pathology

00:03 Let’s take a look at ALL.

00:05 With ALL, acute lymphoblastic leukemia is what I prefer to call it because it’s acute.

00:12 You still expect to find increase in blast count in the bone marrow of greater than 20%.

00:17 Next, it’s lympho.

00:20 Then you have two types, pre-T/pre-B, pre-T/pre-B.

00:25 Can be extramedullary.

00:27 That’s important.

00:28 Call this lymphoblastic lymphoma.

00:30 And where it metastasized is very important, CNS and the testicles, metastasis.

00:37 Acute lymphoblastic leukemia.

00:39 By definition once again, acute, you’re going to find greater than 20% blasts.

00:43 Remember please, this time it will be lymphoblast.

00:46 Smaller than myeloblasts with large nuclei and scant basophilic cytoplasm.

00:51 So cytoplasm is not going to be as abundant as what you find with myeloblast.

00:56 But nonetheless, these are blasts.

01:00 With ALL, quickly for us, we’ll go through tables here to compare and contrast pre-B and pre-T.

01:06 Let’s begin.

01:06 Thank goodness and I say only if your child develops ALL.

01:12 If it’s pre-B, 80% of time, it will be this.

01:16 The reason I said that this is decent is because of prognosis is excellent.

01:20 In pre-T, it’s devastating.

01:24 Let's walk through this just a little bit more.

01:26 Pre-T, where does the T cells gets educated? Thymus, good.

01:31 So now, tons of T -- Let’s say if it was T, type of ALL, Tons of T cells, the thymus is now in a child hyperplasia, hyperplasia, hyperplasia, hyperplasia.

01:44 Oh no.

01:45 Now what happens? In a child, it’s going to compromise the thoracic cavity.

01:49 Compromise perhaps the heart or the lungs.

01:52 Your child is pretty much dead.

01:55 That’s because of death in pre-T.

01:57 Age of onset, childhood.

01:59 Adolescence, a little bit older but still childhood.

02:02 Site: If it’s pre-B, take a look.

02:05 Blood and bone marrow.

02:08 Pre-T, mediastinal mass.

02:10 What does that mean? The thymus.

02:14 Keep that in mind.

02:15 WBC count: Pre-B, low to normal.

02:19 Pre-T, it will be high.

02:22 Prognosis: Pre-B, good.

02:25 Pre-T: Now I want you to connect, mediastinal mass and poor.

02:30 If you find a mediastinal mass in an adolescent or a child and therefore, it will compromise the thoracic cavity and all the organs within it and will kill the patient.

02:40 Poor prognosis.

02:42 Symptoms: Overall, pancytopenia, anemia, thrombocytopenia, leukopenia, neurologic symptoms and bone pain.

02:54 Let’s go into chronic leukemias.

02:56 With chronic leukemia, we’re not going to call these lymphoblastic, myeloblastic.

03:00 No, no, no.

03:01 We will call this chronic myelocytic leukemia and chronic lymphocytic leukemia.

03:08 Same concept as acute but chronic, now, the cells have a little bit more time to mature in the bone marrow.

03:14 You will not find a blast count greater than 20%.

03:18 If anything, you’ll find a blast count to be quite low and a bit less than 10%.

03:23 So more mature leukocyte is the point.

03:26 Chronic mature leukemias.

03:29 We’ll talk about CML, CLL, hairy cell and adult T cell leukemia.