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

by Carlo Raj, MD

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    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.

    About the Lecture

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

    Included Quiz Questions

    1. Testicles
    2. Skeleton
    3. Intestines
    4. Liver
    5. Kidney
    1. Precursor B acute lymphoblastic leukemia
    2. Age less than 2 years
    3. WBC >12,000
    4. Normal cytogenetics
    5. Age >11 years

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

     Carlo Raj, MD

    Carlo Raj, MD

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