Chronic leukemia
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Chronic Leukemia
Chronic Lymphocytic leukemia (CLL)
* Definition:
Chronic neoplastic disorder characterized by accumulation of small mature-looking lymphocytes
which are immunologically immature in blood, bone marrow and lymph nodes.
• It is of B-cell type.
• The cells accumulate in the bone marrow, blood, liver, spleen and lymph nodes.
• Characterized by chronic persistent of lymphocytosis.
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Chronic lymphoid leukemia
* Clinical features of CLL:
1- The disease occurs in older patients (> 50 years old).
2- Total leukocytic count: exceeds 200.000/mm3 with absolute lymphocytosis.
3- (Generalized lymphadenopathy): enlargement of cervical, axillary or inguinal lymph
nodes
4- Hepato-splenomegaly occurs in 50-60% of cases.
5- Features of anemia may be present.
6- Bruising or purpura may occur due to thrombocytopenia.
7- Immunosuppression is a significant problem.
- Bacterial infections followed by viral and fungal infections such as herpes zoster are
also seen.
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Chronic lymphoid leukemia
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Cervical lymphadenopathy
Herpes zoster infection
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Chronic lymphoid leukemia
* Laboratory findings of B-cell CLL:
1- Peripheral blood:
WBCs: Absolute lymphocytosis (↑↑↑ >100.000)
Morphology: - Small mature looking lymphocytes
- Dense chromatin
- Small rim of cytoplasm
RBCs: Normocytic normochromic anaemia is present in later stages.
Platelets: ↓ .
2- Bone marrow: shows lymphocytic replacement of normal marrow elements (> 40%)
3- L.N.: Diffuse infiltration by mature looking lymphocytes.
4- Immunophenotyping: cells express CD5 (+ve in 90% of cases)
Pan B markers +ve: CD19, CD20, CD22
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CLL: This peripheral blood smear is flooded with small
lymphocytes with condensed chromatin and scant
cytoplasm. A characteristic finding is the presence of
disrupted tumor cells (smudge cells).
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Chronic Myeloid Leukemia
Chronic Myeloid leukemia (CML)
* Definition:
- It is a neoplastic proliferation of the pluripotent hematopoietic stem cell.
- The main feature is the presence of Philadelphia chromosome (Ph) which occurs due to
t(9,22) translocation.
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Chronic Myeloid Leukemia
* Clinical features of CML:
1- Affects adults between 25-60 years.
2. Symptoms related to hyper-metabolism due to increased cell turnover (e.g.weight
loss, anorexia, night sweats).
3- Huge Splenomegaly and splenic infarction may occurs.
4- Features of anemia may include pallor, dyspnoea and tachycardia.
5- Gout or renal impairment caused by elevated levels of uric acid may be a problem.
6- In up to 50% of cases the diagnosis is made incidentally from a routine blood
count.
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Chronic Myeloid Leukemia
* Lab findings in CML:
1. Peripheral blood:
* WBCs: >100.000
- Predominantly of neutrophils, metamyelocytes and myelocytes exceed those of
blast cells and promyelocytes
- Increased circulating basophils and esinophils.
* RBCs: Normocytic normochromic anaemia.
* Platelets: ↑↑
2. Bone marrow: Hypercellular with predominance of granulopoiesis
3. Cytogenetics: Philadelphia chromosome
4. Serum uric acid is usually high.
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Chronic Myeloid Leukemia
CML: peripheral blood film showing many mature
neutrophils, some metamyelocytes, and a
myelocyte.
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Thanks
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