*Leukemia

Differentiating between Acute and

Chronic

Group 3: Christopher Phipps

Karlene Irwin
Alwyn Coleman
Tamarie Price
*
* Named after the leukocytes, white blood cells which
mutate before maturity and become cancerous.
* Leukemia is termed as a type of cancer that affects the
blood and bone marrow, the spongy center of bones
where our blood cells are formed. The disease develops
when blood cells produced in the bone marrow grow out
of control.
* These cells reproduce rapidly, suppressing production of
normal white cells that are essential to fighting infection in
the body, and red cells that are needed to carry oxygen in
the blood. Cancer cells may spread to the liver, spleen,
lymph nodes, genitals, or the brain.
*
* Acute leukemia is characterized by a rapid increase in the numbers
of immature blood cells. Crowding due to such cells makes the bone
marrow unable to produce healthy blood cells. Immediate
treatment is required in acute leukemia due to the rapid
progression and accumulation of the malignant cells, which then
spill over into the bloodstream and spread to other organs of the
body. Acute forms of leukemia are the most common forms of
leukemia in children.
* Chronic leukemia is characterized by the excessive build up of
relatively mature, but still abnormal, white blood cells. Typically
taking months or years to progress, the cells are produced at a
much higher rate than normal, resulting in many abnormal white
blood cells. Whereas acute leukemia must be treated immediately,
chronic forms are sometimes monitored for some time before
treatment to ensure maximum effectiveness of therapy. Chronic
leukemia mostly occurs in older people, but can theoretically occur
in any age group.
*

Acute Leukemia Chronic Leukemia

Age group All ages Adults
Clinical onset Sudden Insidious
Course (untreated) Les than 6 months 2-6 years
Leukemic cells Immature Mature
Anemia Mild to severe Mild
Thrombocytopenia Mild to severe Mild
White blood cell count Variable Increased
organomegaly Mild Prominent
 * Acute Leukemia

* Usually diagnosed incidentally based on high white

blood cell counts

* Divided into two groups based on cell of origin:

Acute Acute Myelogenous

Lyphmhocytic Leukemia
Leukemia
 *Acute Leukemia

*Bone Marrow failure

*Anemia
*Thrombocytopenia
*Neutropenia
*DIC
*Lymphadenopathy
*CNS involvement
 Laboratory findings of Acute Leukemia

* Pancytopenia

30%
*

*Proliferation of blasts

*Disorder originates in a
single B or T
lymphocyte progenitor
 * Laboratory findings of Acute Leukemia

* Acute lymphocytic Leukemia (ALL) will have granules in

blast cells. A special cell marker called TdT is present in
95 percent of cases. It is subtyped to either B-cell or T-
cell type.
 * Laboratory findings of Acute Leukemia

* Other lab findings may include disseminated intravascular

coagulation (DIC), which is a severe depletion of clotting
factors in the blood.
* Uric acid level may be elevated. Lumbar puncture (spinal
tap) will show
 *

*(AML) occurs froom children up

to adults and more commonly
in men than women.
*AML is treated with
chemotherapy.
*The five-year survival rate is
40%.
 * Laboratory findings of Acute Leukemia

* Acute myelogenous Leukemia (AML) shows Auer rods in

the blast cells. Special stains may also be done: Sudan
Black
 *

*Acute myeloid leukemia, without maturation

 *

*Acute myeloid leukemia, with maturation

 *

*Subtypes of AML include acute

promyelocytic leukemia, acute
myeloblastic leukemia, and
acute megakaryoblastic
leukemia.
 * Chronic Leukemia

* Usually diagnosed incidentally based on high white

blood cell counts

* Divided into two groups based on cell of origin:

Chronic
Chronic
Myelogenous
Lyphmhocytic
Leukemia
Leukemia
 *

*Most frequently a neoplasm of

B lymphocytes
*Malignant proliferation of T
cells less common.
 *

*Characterized by peripheral
blood and bone marrow
lymphocytosis
*Proliferation of more mature
(non-blast cells)
*Lymphocyte either slightly
smaller/larger than the
normal lymphocyte
*Hypercondensed, “soccer
ball” appearing nuclear
chromatin pattern
*Bare nuclei or smudge cells
common
 *

*Increased (greater than

10%) prolymphocytes
*Larger proliferative
lymphocytes have
exaggerated nuclear
irregularities, lobulations
or nuclear folds
*Increased
lymphoplasmacytoid cells
(mixed type)
 *

*Neutropenia
*Anemia
*Thrombocytopenia
*General
pancytopenia due to
accumulating
lymphocyte mass
 *

*(CML) occurs mainly in adults

*Treatment is with imatinib
(Gleevec in US, Glivec in
Europe) or other drugs.
*The five-year survival rate is
90%.
*A subtype of CML is chronic
monocytic leukemia.
 *

*Neutrophil maturationseen in CML

 *

*Increased RBC in PV (polycythemia rubra vera)

 *

*Teardrop RBCs in MMM (myeloid metaplasia)

 *

*Increased Thrombocytes in ET
(Essential thrombocythemia)
*French-American & British
Classification

*
M 0- Acute myeloblastic leukemia without morphological and
cytochemical maturation.
M1- Acute myeloblastic leukemia with minimum morphological
and cytochemical maturation.
M2- Acute myeloblastic leukemia with
Maturation.
M3 - Acute promyelocytic leukemia,
hypergranular *
M3m- Acute promyelocytic leukemia,
Microgranular.
M4- Acute myelomonocytic leukemia.
M4E0 - Acute myelomonocytic leukemia
with eosinophilia.
M5a- Acute monoblastic leukemia,
poorly differentiated.
M5b- Acute monocyti leukemia, with
differentiation
M6- Erythroleukemia
M7- Acute megakaryoblastic leukemia
 *

*Harmening, DM. Clinical hematology and

fundamentals of hemostasis. 5th ed.
*Ciesla Betty,. Haematology in Practice. F.A. Davis
Company, (2007) Philadelphia, PA.