blood Leukemia - tumors of the hematopoietic system, primarily affects the blood-forming bone marrow cells.Blood Leukemia is divided into two main types of blood of leukemia - acute and chronic.Cell substrates are acute leukemia blast cells, chronic leukemia - mostly mature elements.In this article we will discuss the symptoms of leukemia, and the main causes of leukemia in humans.
Symptoms of leukemia
Clinical symptoms of leukemia blood is the same for all types of leukemia.Start of leukemia can be sudden.Severe condition of the patient with symptoms of leukemia on admission to hospital may be due to such factors as: severe intoxication, hemorrhagic syndrome (result thrombocytopenia), respiratory failure (due to compression of the airway enlarged hilar lymph nodes).Perhaps the gradual development of leukemia.Patients with leukemia complain of symptoms: loss of appetite, decreased disability, pain in bones, joints, tumor formation in the neck, armpits (enlarged lymph nodes).
Symptoms of acute leuke
acute form of leukemia - a malignant disease of the hematopoietic system, morphological substrate - blasts.There are acute lymphoblastic type of leukemia (ALL) and acute myeloid type of leukemia (AML).
incidence of acute leukemia type
incidence of acute leukemia type 13.2: 100,000 men and 7.7: 100,000 women.Symptoms of acute type of leukemia usually develops in childhood and after age 40.The frequency of acute type of leukemia is the same in all age groups.
Symptoms of leukemia acute type
Pathogenesis is caused by the proliferation of a clone of tumor cells with the characteristic symptoms of cytogenetic disorders in leukemia, inhibition of normal hematopoiesis, the release of blast cells in the blood, metastasis into other hematopoietic (spleen, liver, lymph nodes) and non-hematopoietic (skin, CNS, testicles, lungs) bodies.
classification of acute leukemia type
The classification of acute forms of leukemia put appearance and cytochemical signs of blast cells, their immunophenotype and genetic features.For example, the French-American-British (FAB) classification based on morphology of leukemic cells (structure of the nucleus, the ratio of the nucleus and cytoplasm sizes).
acute myeloid leukemia views - symptoms
Intensive study of cytogenetic and immunological symptoms Leukemia led to the adoption of classification of acute myeloid leukemia.The level of differentiation of lymphoid cells shows the expression on the surface of the nuclear membrane in leukemia, in the cytoplasm and the cytoplasmic membrane of various Ar, "cluster of differentiation", abbreviated as CD (from the English. Cluster of differentiation).
syndromes of bone marrow failure, leukemia
syndromes caused by bone marrow failure that occurs as a result of inhibition of normal hematopoiesis blast proliferation, as follows.
symptoms of anemia: paleness, shortness of breath, palpitations, drowsiness.
propensity to infections (bacterial, viral and fungal).The clinical picture is observed as light (local) forms of infections, such as symptoms of thrush, gingivitis, lesions of the mucous membranes caused by the herpes simplex virus, and severe generalized processes (pneumonia, sepsis) in leukemia blood.
Symptoms of hemorrhagic syndrome in leukemia.On examination reveals petechiae and ecchymosis of the skin (spontaneous, at injection, mechanical friction).There are intense nose and severe internal bleeding (metrorrhagia, gastrointestinal bleeding, bleeding in the brain).
DIC.When symptoms promyelocytic leukemia often develop DIC.
Signs of specific lesions in leukemia
- Intoxication symptoms: fever, weight loss, loss of appetite, weakness, sweating reinforced.
- bones Soreness (especially tubular, spine), arthralgia - a characteristic symptom of leukemia.
- lymphadenopathy in leukemia.You can zoom in any group of lymph nodes.Feature: multiple, thick, flexible, round, can be soldered to each other, of different sizes (1 to 8 cm);palpation painless.The increase in mesenteric lymph nodes, and hypertrophy of the appendix as a lymphoid organ can cause abdominal pain.Hypertrophic hilar lymph nodes can cause compression of the mediastinum.
- enlarged liver and spleen - a characteristic symptom of leukemia.
- Neuroleukemia the symptoms of leukemia.CNS involvement (neuroleukemia) occurs most frequently in ALL and significantly worsens the prognosis.Occurrence neuroleukemia due to metastasis of leukemic cells in the brain and spinal cord or in the brain tissue (intratumor, prognostic heavier type of tumor growth).The neurological manifestations may be of varying severity - from mild cerebral symptoms (headache) to focal lesions (impaired consciousness, impaired vision, discoordination movements, dysphasia).
- hypertrophy of the gums can be a symptom of leukemia.
- skin Leykemidy (specific nodules) occur more frequently in myeloma-noblastnom and monoblastny types of acute myeloid leukemia.
- mediastinum.Hypertrophy of thymus can cause compression of the mediastinal organs in leukemia.
- testicles.Perhaps testicular lesion (often with relapses);testicles are enlarged, asymmetric, painless.
- Symptoms of renal damage is rare (it is possible tubulointerstitial nephritis).
main cause of leukemia is chromosomal abnormalities.In the majority of cases of acute leukemia, they determine the cause of the disease and the type of specific treatment.Instability of the genome of leukemia cells may be the cause of the original tumor clone new subclones, including during the life of the organism, as well as under the influence of treatment of "selected" the most self-contained.This explains the phenomenon of progressive course of leukemia, leaving them out of control of cytostatics, change of place of tumor growth, and that is the essence of tumor progression characteristic of malignant growth.Gradually normal hematopoiesis is suppressed in leukemia.
Types blood leukemia
acute form of leukemia blood
acute form of leukemia blood without treatment leads to death within a few weeks or months.If untreated, the prognosis for children is often favorable.Acute leukemias are divided into myeloid and lymphoid.
chronic form of leukemia blood
Patients with this type of leukemia live without treatment within a few months and years.Chronic leukemias are divided into myeloid, and megakaryocytic lymph.Causes of leukemia is unknown.
diagnosis of leukemia
laboratory and instrumental diagnosis of leukemia
Suspected blood leukemia arises in the presence of clinical symptoms and changes in peripheral blood following:
- normochromic normocytic anemia;
- number of leukocytes may be different - low (below 5 YU9 / L), normal (5- 109/109 l to 20 / l), increased (over 20 o 109 / l, in some cases reaching 200 109 o/ l);
- neutropenia (does not depend on the total number of white blood cells);
- absolute lymphocytosis;
- thrombocytopenia (almost always present);
- "leukemic failure" - the presence of blasts, mature forms in the background of the lack of intermediate forms;
- in Acute Myeloid Leukemia form can be found azurophile granules and Auer rods.
puncture bone marrow with leukemia symptoms blood
puncture of the bone marrow - the main method of research in leukemia blood.It is used to confirm the diagnosis and identification (morphological, immunophenotypic, cytogenetic) type of leukemia.Bone marrow aspiration may be difficult due to its depletion (suppression of hematopoiesis) and increased content in it fibrous structures.
Myelogram (quantitative determination of all cellular forms of bone marrow) with symptoms of acute leukemia:
- increase of blasts and more than 5% to the total blastosis;
- blast morphology is different depending on the type of leukemia;
- increase of intermediate forms;
- red sprout oppressed hematopoiesis (except acute erythremic myelosis);
- absent megakaryocytes or their number is insignificant (except acute megacaryoblastic type of leukemia).
cytochemical study - the main method of diagnosis of acute leukemia blood types.It is conducted in order to identify specific blasts various enzymes.So, when OJIJT determined positive Schick reaction to glycogen, a negative reaction to lipid peroxidase, hloratsetatesterazu.In acute myeloid leukemia types - positive reaction to myeloperoxidase, lipids, hloratsetatesterazu.Schick reaction depends on the form of acute myeloid leukemia.
Immunophenotyping blasts carried out by automated method to flow cytometry or ELISA on glass using light microscopy.The latter has the advantage of the symptoms of leukemia blood, it may be carried out in parallel with the cytochemical study.Immunophenotyping to determine with monoclonal AT presence or absence of clusters of differentiation of blast cells (CD-markers).His conduct in the first place it is necessary for an accurate diagnosis of ALL, and in difficult cases, the differential diagnosis of acute lymphoblastic and myeloid leukemia.This is a fundamental point, because the treatment of these types of blood leukemia is different.
Cytogenetic study of leukemia cells to determine chromosomal abnormalities and further prognosis of this type of blood and causes leukemia.
Other obligatory primary research methods for various reasons leukemia
study of cerebrospinal fluid when the symptoms of leukemia.Increased cell count due to blasts indicates neuroleukemia.
X-ray examination of the chest blood in leukemia: the expansion of the shadow of the mediastinum due to increased intrathoracic lymph nodes, leykemidy in the lungs.
Biochemical blood test, ECG, echocardiography, EEG needed to determine the baseline of vital organs and functions are carried out before and during chemotherapy, as applied cytostatics have cardiotoxic, hepatotoxic and nephrotoxic properties in leukemia blood.
ultrasound with symptoms of leukemia blood: enlargement of the liver and spleen, leukemoid infiltration foci in the parenchymatous organs.
Differential diagnosis of blood leukemia
Infectious mononucleosis may be associated with an increase in spleen, fever, appearance of altered lymphocytes (large, with a broad rim of cytoplasm, can be taken as blasts) on the background of typical symptoms (cyclical disease, sore throat, jaundice, cardiomyopathy, mononuclear cells in the blood, positive serological response to Epstein-Barr virus).
HIV infection when symptoms of leukemia blood.Generalized lymphadenopathy characteristic of HIV infection.The definitive diagnosis of HIV infection put in the presence of viral markers in blood.
Pancytopenia - leading laboratory symptom of aplastic anemia and leukemia blood.The characteristic morphological pattern of the bone marrow - the replacement of hematopoietic tissue fat, reduced cellularity, no blasts.In the history of possible reception of drugs (toxic substances), causing aplasia.Pancytopenia may be caused by an autoimmune related processes, such as SLE.Under appropriate syndromes (symptoms: a skin lesion, the kidneys, the cardiovascular system) are lupus blood cells in blood of leukemia.Pancytopenia is characteristic of vitamin B12-deficiency anemia.In history - associated pathology, surgery on the gastrointestinal tract.The clinical picture of the three leading syndrome - anemia, trophic disorders, funicular myelosis.In the peripheral blood and bone marrow - megaloblasts.The positive effects of treatment with vitamin Bi2, folic acid.
leukemoid reaction - a significant increase in the number of leukocytes with a shift leukocyte left.The reason leukemoid tests for leukemia may be severe inflammatory disease, use of certain medications (prednisone).Unlike acute leukemia, leukemoid blast type are no reactions.