Hematology topic. Investigations in leukemia. (Question and answers)

1. INVESTIGATION OF LEUKEMIA

2. CHART-1
• 10 years old boy
presented with fever
and generalised
lymphadenopathy of 3
months duration.
• Investigation done
 Hb%- 6gm/dl
 TLC- 80,000 Cells/cmm
 Platelet count-60,000
cells/cumm

3. 1. What is your diagnosis?
2. How do you classify this disease?
3. What are the other investigation indicated
for confirmation?

4.  Ans.1-Diagnosis- Acute lymphoblastic leukemia
 Ans 2.- FAB classification based on morphology and
cytochemistry

5. Ans.3- other investigations-
• B.M. examination- hypercellular with >20%
lymphocytes
• Cytochemistry- PAS Stain- block like positivity
• Immunological marker for Tcell or Bcell

6. CHART-2
• 50 years old female
presented with fever,
weight loss, bleeding
gums and
hepatosplenomegaly
since 6 months
• Investigation done
 Hb%-6.8gm/dl
 Tlc- 96000cells/cumm

7. 1. What is the diagnosis?
2. Classify the disease you have diagnosed
3. What is the special stains for confirmation?

8.  Ans 1.-Diagnosis- Acute myleloblastic leukemia
 Ans.2- WHO classification of AML

9. Ans.3- Special stains-
• Myeloperoxidase
• Sudan black B
• Specific and non specific esterase positive in
M4 & M5
• Serum muramidase is increased in M4 & M5

10. CHART-3
• 40 years old male
presented with
weakness, dyspnoea,
pallor, weight loss &
massive splenomegaly
• Investigations done-
 Hb%- 9.6gm%
 TLC-200000cells/cumm

11. 1. What is your diagnosis and differential
diagnosis?
2. What is the chromosomal abnormality?
3. What is blast crisis and types of blast crisis?

12.  Ans.1-Diagnosis- chronic myeloid leukemia
DD- Leukemoid reaction
 Ans.2- philadelphia chromosome
 Ans.3- blast crisis- it is transformation of disease into acute
leukemia. It is characterised clinically by fever, fatigue,
anorexia, night sweats, bone pain and lymphadenopathy.
Hematologically characterised by increasing blast cell (>30%),
increasing basophilia and thrombocytosis.
 Blast crisis types- myeloblastic or lymphoblastic.

13. CHART-4
• 60 years male
presented with fever,
weight loss, generalized
lymphadenopathy and
mild splenomegaly.
• Investigations done-
 Hb%- 10 gm/dl
 Tlc- 1,40,000-
cells/cumm

14. 1. What is the diagnosis?
2. What are the complications?
3. What is the bone marrow picture?

15.  Ans.1-Diagnosis- chronic lymphocytic
leukemia
Ans.2- complications-
• Acquired autoimmune hemolytic anemia
• Bacterial infection
• Thrombocytopenia with petechial ecchymosis
• Meningeal infiltration
• Transformation to acute phase blast crisis

16. Ans. 3- B.M. Picture-
• B.M. hypercellular
• Increased lymphocyte count
• Reduced myeloid precursor
• Reduced erythroid precursor

17. CHART-5
• 65years old female
presented with fatigue,
weakness, weight loss
and low back ache.
• X-Ray- lytic lesions of
bone seen
• Investigation done-
 Hb%- 9.80gm/dl
 ESR- 120mm at the end of
one hour( westerngreen’s
method)

18. 1. What is the diagnosis
2. What are the urinary finding in the disease?
3. What are the radiological findings?
4. What are the biochemical changes found in
this disease( serum & urine)?

19. Ans. 1-Diagnosis- multiple myeloma
Ans.2- Urinary findings-
• Bence jones proteinuria
• Albuminuria
• Hypercalciuria

20.  Ans.3- Radiological findings-
• Multiple punched out osteolytic lesions
• Diffuse osteoporosis
• Pathological fractures
• Osteosclerosis
 Ans.4- Biochemical findings in serum-
• Hyperglobulinemia, increased M- protein
• Hypercalcemia
• Hyperuricemia
• Alkaline phosphatase increased in ostesclerotic bone lesion

21.  Biochemical findings in urine-
• Bence jones proteinuria
• Albuminuria
• hypercalciuria

22. SLIDES

23. CHRONIC MYELOID LEUKEMIA

24. ACUTE MYELOBLASTIC LEUKEMIA