Chronic myeloid leukaemia

1,362 views

Published on

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,362
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
35
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Chronic myeloid leukaemia

  1. 1. MYELOPROLIFERATIVE NEOPLASM CHRONIC MYELOID LEUKAEMIA
  2. 2. HISTORY 45 year old present with fatigue and abdominal distention for the past 6 months. O/E he is pale and his spleen 5cm below coastal margin. His CBC reveals Hb 10.5g/dl, TLC 120x109 /L and Platelet count of 550x109 /L.
  3. 3. Chronic myelogenous leukaemia Chronic granulocytic leukaemia Clonal disorder Acquired genetic change in pluripotent haemopoietic stem cell
  4. 4. Rare below 20 years of age Median age of onset is 50 – 60 years Biphasic or triphasics disease Intial chronic/indolent or stable phase which evolves into an advanced phase
  5. 5. Cytogenetics Translocation of chromosomal material between long arms of chromosome 22 and chromosome 9, an event referred to as t(9;22) (q34:q11) Generates BCR-ABL fusion gene on Philadelphia chromosome
  6. 6. Ph chromosome
  7. 7. Ph chromosome
  8. 8. bcr/abl translocation by FISH Normal nuclei (n) exhibiting 2 orange and 2 green signals. Ph chr. showing Yellow fusion signal of orange and green signals ( arrows
  9. 9. bcr/abl translocation by FISH
  10. 10. Presentation Abdominal discomfort or progressive enlargement Weight loss Lethargy Loss of energy Shortness of breath Visual disturbances
  11. 11. Presentations Spontaneous bruising Bleeding gums Infections
  12. 12. Diagnosis CBC Anaemia Raised TLC DLC Full spectrum of granulocytic cells ( Blast, myelocyte, metamyelocyte, band cell, Neutrophils)
  13. 13. Eosinophils Basophils Platelet count raised Bone marrow examination: Degree of fibrosis Cytogenetic analysis Exclude incipient transformation
  14. 14. Raise LDH Reduced LAP score Raised vit B12 levels Hypercalcaemia Raised serum uric acid
  15. 15. Phases Chronic Phase: Ability to reduce spleen size and restore and maintain a normal blood count with therapy Blast cell percentage is less than 10% Eosinophils and basophils are normal in number
  16. 16. Accelerated Phase: Blast 10 – 19% Persistent thrombocytopenia unrelated to therapy or thrombocytosis unresponsive to therapy Increasing spleen size and counts unresponsive to therapy Megakaryocyte proliferation and reticluin or collagen fibrosis
  17. 17. Blastic Phase: Blast >20% Extramedullary blast proliferation

×