LEUKEMIA
DR. AYESHA JUNAID
MBBS,MCPS,FCPS.
Professor of Pathology
Consultant Haematology
Incharge Blood Transfusion Services-SIH
Leukemia
OBJECTIVES
What is leukemia?
What is the Pathogenesis of Leukeima?
How do we classify leukemia?
(WHO 2008 classification)
Leukemia
OBJECTIVES
What is their clinical presentation?
How do we diagnose leukemia in laboratory?
What are the basic principles of
management?
Leukemia vs Leukemoid Reaction





Leucocytosis
Neutrophilia,Eosinophilia,Lymphocytes
Leucopenia
Leukemoid Reaction
Leukemia
Leukemia
Myeloid cells
 Mitotic pool (blast to myelocytes)
 Maturation pool (ends with the mature
neutrophil)
 Storage pool (Mature neutrophils
residing in the bone marrow)
LEUKEMIA
Leukemia is a disease resulting from the
neoplastic proliferation of hemopoeitic
or lymphoid cells
LEUKEMIA
 It results from the mutation in a single
stem cell
 The progeny of which form a clone of
leukemic cells
LEUKEMIA
 Genetic events contributing to malignant
transformation include
 Inappropriate expression of oncogenes
 Loss of function of TSG
LEUKEMIA CLASSIFICATION
LINEAGE & DEGREE OF MATURATION
MORPHOLOGY
CYTOCHEMICAL
CYTOGENETICS
IMMUNOPHENOTYPICAL
IMMUNOHISTOCHEMISTRY
MOLECULAR GENETICS
LEUKEMIA CLASSIFICATION
WHO 2008
 Evidence based classification for daily
therapeutic decisions.
 Provides a flexible framework for
integration of new data
LEUKEMIA
 Acute leukemia
 Chronic leukemia




Acute Myeloid Leukemia
Acute Lymphoid Leukemia
Chronic Myeloid Leukemia
Chronic Lymphoid Leukemia
ACUTE LEUKEMIA
Heterogeneous group of clonal disorders
arising from
•
Pluripotent stem cells
•
Clinical course
•
Response to therapy
ACUTE LEUKEMIA
 Acute leukemia accounts for
approximately 10% of all human cancers
 Is the leading cause of cancer deaths in
adults younger than 35 years of age
BONE
MARROW
TREPHINE
HIGH AND
LOW POWER
CYTOCHEMISTRY
 It identifies diagnostically useful enzymes
or other cytoplasmic substances of
hemopoietic cells
 Particularly useful for identification of
immature cells in leukemia
 SUDAN BLACK B
 PERIODIC ACID SCHIFF(PAS)
 ACID PHOSPHATASE
Leukemia
AML/ALL MORPHOLOGY
Differentiation on morphological grounds
alone is not possible
Morphological features favoring lymphoid
derivation include
 Blasts including relatively condensed
chromatin
 Absence of conspicuous nucleoli
 Presence of scanty agranular cytoplasm
CYTOCHEMISTRY
CYTOCHEMISTRY
PAS
ACUTE LEUKEMIA
ALL
AML
ACUTE LEUKEMIA
CLINICAL FEATURES
ONSET
Abrupt, acute
Insidious, slowly progressive
Bone marrow malfunction
Anemia, infection & bleeding
ACUTE LYMPHOBLASTIC
LEUKEMIA
CLINICAL FEATURES

Bone pain & tenderness

Lymphadenopathy

Splenomegaly

Hepatomegally

CNS manifestations

Testicular involvement

Skin
LEUKEMIA
LABORATORY EVALUATION




Anemia
Leukocytosis/leukopenia/normal TLC
Thrombocytopenia
Bone marrow examination
Aspirate & biopsy
LABORATORY EVALUATION
LEUKEMIA