Presented by Reeta Sharma Moderated by Dr. Amar Ranjan B.Sc.

M LT (III Year)

Chronic Leukaemia
Stem Cell diseases

Gradual onset
Patient unwell for Years Patient can Survive for Longer time

Features of Chronic Leukaemia

Neoplastic Proliferation

Differentiated cells like

(i) Myelocytes ,Metamyelocytes (ii) Neutrophils , Few Blasts (iii) Small mature Lymphocytes

CLASSIFICATION OF LEUKAEMIA

Chronic Myeloid Leukaemia

- Chronic Myeloproliferative diseases Also called as- Chronic Granulocytic Leukaemia

- Chronic Myelogenous Leukaemia

Chronic myeloid leukemia(40X)

ETIOLOGY OF CML
-Exact etiology is not known

GENETIC FACTORS
- Chromosomal aberration of Philadelphia Chromosome - Uncontrolled Proliferation of Granulocyte precursor

 IONIZING

RADIATION
Evidences are

Survivors of Hiroshima & Nagaski atomic Blast Patient of Ankylosing Spondylitis

HLA CW3, CW4 associated with CML

EPIDEMIOLOGY
CML is commonest Leukaemia

Male are more affected then female AGE - 20 40 Years are affected - Less then 20 Years diseases uncommon

CLINICAL FEATURES
- Tiredness Abdominal pain - Weight loss & Excessive sweating - Spleenomegaly - Hepatomegaly - Lymphadenopathy

INVESTIGATION OF CML

Hematological Findings-PBF finding

-Bone Marrow finding

Other Investigations

Hematological

Finding

- Aneamia Hb - Leucocytosis TLC

- Platelet count -

ROMANOWSKY STAINS

CYTOCHEMICAL STAINS

- Leishman Stain

- Sudan Black B (SBB)

- May Grunwald Giemsa

- Wright Stain - Jenners Stain - Giemsa Stain

- Myeloperoxidase(MPO)
- Leucocyte Alkaline Phosphatase (LAP) - Periodic acid & Schiffs (PAS)

Immature white cells seen like-Neutrophils -Myelocytes

-Metamyelocytes
-Promyelocytes -Blast cells Basophilia & Eosinophilia Neutrophil alkaline Phosphatase Decrease (NAP ) )

BONE MARROW

Bone marrow aspirate

Triphine biopsy with Touch Imprints

- Smear prepared from Aspirates

- Touch imprints from Triphine biopsy Stained by

Triphine biopsy Processed in Histopathology

Processing same as for Routine Tissue Sections Stained with - Haematoxylin & Eosin MGG

ROMANOWSKY STAINSLeishman / MGG CYTOCHEMICAL STAINSSBB , MPO , LAP, PAS

- PAS & Retics

Other Investigations-

CHRONIC LYMPHOID LEUKAEMIA

- Accumulation of Neoplastic mature Lymphocytes in - Bone Marrow - Lymph node
ALSO CALLED AS

Chronic Lymphocytic Leukaemia

CHRONIC LYMPHOID LEUKEMIA(40X)

CLL IN BONE MARROW(40X)

EPIDEMOLOGY
Twice common in Men then Women

Incidence low in india AGE Majority of cases between 45 65 Year

ETIOPATHOLOGY
- Exact etiology not known

FACTORS

Genetic factors Cytokinin Play key role in Leukaemic Process

GENETIC FACTORS-

High incidence of CLL in some families

Some family member have CLL & Some have immune deficiencies

CYTOKININ
Transformation growth factor-Beta (TGF-Beta) Tissue necrotic factor - Alpha (TNF-Alpha)

Inter leukin (IL-2)

Induces proliferation of Leukaemic cells

CLINICAL FEATURES

Age: Disease of old age

Sex: More common in men (2:1) Fatigue

Lymphadenopathy
Spleenomegaly

Hepatomegaly

Pallor
Skin Rashes Asymptomatic Infections

Haematological Finding Bone Marrow Finding

Immunophenotyping

HAEMATOLOGICAL FINDINGS
Hb
TLC DLC Lymphocytosis Platelet count - Normal Coombs Test : +ve in 10 20 % cases of CLL due to Auto Immune Haemolytic anaemia

Hypercellular Bone marrow

Myelopoiesis Erythropoiesis Megakaryopoiesis Lymphocytic Infiltrates - > 30 % of Nucleated cells are mature Lymphocytes

Immunophenotyping is Technique used To detect cell Surface Antigen Receptor at various stages of Differentiation Neoplastic mature lymphocytes arises by clonal expansion of B-cells

+ve for Pan B cell marker like- CD19, CD20,CD21 CD5, CD23 +ve for CLL