Leukemias I.

Definition: Leukemia appears to be a clonal disease resulting from the abnormal uncontrolled proliferation of a single stem cell from which a new clone of cells develops. For some unknown reason, these abnormal cells have a selective growth advantage over normal cells. Present data indicate that these cells are functionally different and biochemically abnormal. Etiology is Unknown: A. Possible Causes

II.

Viruses are the proven etiological agent in some animal leukemias, and may well be the causative agent in some human leukemias as well. Marrow damage due to irradiation increases the frequency of some leukemias, but not others. A variety of chemicals and drugs have been implicated as possible etiological agents of leukemia, especially benzene. Possible genetic factors have been implicated, especially in Chronic Lymphocytic Leukemia. Presenting Symptoms include hemorrhage and/or infection Acute Leukemias-General Characteristics

B. C.

D. III. IV. A. B. C. D. E. F. G. H.

Sudden onset Rapidly Progressive Course anemia, usually Normocytic, Normochromic usually decreased platelet count Bone marrow packed with blasts WBC count variable Accounts for 60% of all leukemias Often divided into 2 groups based on differences in methods of treatment:

V.

1. ALL- Acute Lymphocytic Leukemia 2. ANLL- Acute Non Lymphocytic Leukemia Chronic Leukemias - General Characteristics

A.

In the initial stages of the disease, anemia is not present, however by the time of diagnosis, a normocytic, normochromic anemia is usually evident. Pronounced leukocytosis generally occurs. Platelets are generally normal to increased at first, but as disease progresses, thrombocytopenia often occurs due to impaired production and/or increased pooling of platelets in the spleen. No leukemic hiatus Insidious Onset Accounts for 40% of all leukemias

B. C.

D. E. F.

VI. Subleukemic Leukemia A condition in which the WBC is decreased but a sufficient number of cells are present to suggest a diagnosis of leukemia. VII. Aleukemic Leukemia

A condition in which the bone marrow shows signs of abnormal cell proliferation, but no abnormal cells are seen in the peripheral circulation. VIII. Preleukemia An abnormality which, after several months or even years, develops into a specific leukemia, somehow predisposing the person to the development of leukemia. Diseases or conditions known to be preleukemic include: Polycythemia vera Myelofibrosis Aplastic Anemia Pure Red Cell Aplasia (Blackfan-Diamond Syndrome) PNH Ideopathic Refractory Sideroblastic Anemia IRSA Chromosomal Abnormalities, i.e. Down's Syndrome Exposure to radiation or to benzene Absolute Monocytosis over a prolonged time
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