Acute Lymphoblastic leukemia presentation ppt

2. MSc Biomedical Science Haematology (London UK)
BS Hons MLT (RMC)

3.  Presence of > 30% blasts in the bone marrow
at clinical presentation

4. Acute Lymphoblastic Leukaemia is
the common form of leukaemia in
children
Its incidence is highest at 3 – 7 years,
falling off by 10 years.
There is a lower frequency of ALL
after 10 years of age with a secondary
rise after the age of 40.

5. CLINICAL FEATURES OF
ACUTE LYMPHOBLASTIC
LEUKAEMIA
Clinical features are secondary to the following:
1. Bone Marrow Failure leading to:
- Anaemia (pallor; lethargy; dyspnoea)
- Neutropenia (fever; malaise; features of mouth ,
throat, skin, respiratory, perianal or other infections)
- Thrombocytopenia (spontaneous bruises; purpura;
bleeding gums and menorrhagia)
2. Organ infiltration – tender bones, lymphadenopathy,
moderate splenomegaly, hepatomegaly
If CNS involvement then headache, nausea,
vomiting blurring of vision and diplopia
Testicular infiltration

6. Marked cervical lymphadenopathy
in in a patient with Acute Lymphoblastic
Leukaemia

7. Purpura over the lower limbs in a
Patient with acute leukaemia

8. FAB Classification of Acute Lymphoblastic leukaemia
ALL – L1: Small monomorphic blasts with high N:C ratio
ALL – L2: Large. hetrogenous,nucleolated , low N:C ratio
ALL - L3: Burkitt type , basophilic and vacuolated
cytoplasm. (B-ALL)
The L1 blast show uniform, small uniform, small blast
cells with scanty cytoplasm.
The L2 type comprise mixed population of small and
large blasts with more prominent nucleoli and cytoplasm.
The L3 blasts are large with prominent nucleoli.
strongly basophilic cytoplasm and cytoplasmic vacuoles.
FRENCH AMERICAN AND BRITISH (FAB)
CLASSIFICATION OF ACUTE LYMPHOBLASTIC
LEUKAAEMIAS

9. Acute Lymphoblastic Leukaemia:
FAB Type ALL – L1
Lymphoblasts show monomorphic
appearance, very high N:C ratio;
Nucleoliare indistinct; Chromatin is
course and there is condensation
of chromatin along nuclear membrane
P. Film analysis

10. Acute Leukemia - Morphology
ACUTE LYMPHOBLASTIC LEUKEMIA
L1 - small cells with scant cytoplasm

11. Acute Lymphoblastic Leukaemia FAB Type ALL – L2
Large Heterogeneous population of blast cells; Nucleolated;
Low N: C ratio.

12. Acute Leukemia - Morphology
ACUTE LYMPHOBLASTIC LEUKEMIA
L2 - Large cells with variable cytoplasm, irregular
nuclear contours with clefting, and prominent one or
more nucleoli.

13. Acute Lymphoblastic Leukaemia FAB Type ALL – L3:
Lymphoblasts with strongly basophilic cytoplasm and showing
vacuolation. (B-ALL)

14. Acute Leukemia - Morphology
ACUTE LYMPHOBLASTIC LEUKEMIA
L3 - Medium to large cells
with moderately
abundant intensely
basophilic cytoplasm
and prominent
cytoplasmic vacuolation,
regular nuclear contours,
prominent nucleoli.

15. Acid Phosphatase staining in ALL: Showing cytoplasmic positivity; Localized
staining in the Golgi zone. Reaction is typical of T- ALL

16. Periodic Acid Schiff (PAS) stain (Identifies glycogen, polysaccharides
and mucin)
in Acute Lymphoblastic Leukaemia
Block Positivity of Cytoplasm. Typical of B- ALL

17.  WBC normal, upto 200*109/l or ( 4.00-11.0 x
10 9/L)
 P film morphology
 Bone marrow hypercellular >30% leukemic blasts
 X-rays lytic bone lesions & mediastinal mass
 Immunophenotyping CD2,CD3,CD7 positive in T-
ALL
 Cd 79a, CD19,CD22,CD10 positive in B-LL
 Cytogenetic analysis
 Biochemical tests uric acid , serum LDH hyper
calcemia
 Lumbar puncture CSF pressure & Leukaemic cells

20. Determinant Favourable Unfavourable
Age 3-7 yrs <1, >10 yrs
Sex Female Male
Race White Black
WBC Count <10 X 10 9/l >50 X10 9/l
Time of Remission <4weeks >4 weeks
Organomegaly Absent Massive
Mediastinal mass Absent Present
CNS Leukaemia Absent Present
FAB Morphology L1 L2,L3
Immunophenotype Early Pre B cell T-cell,B-cell
Cytogenetics Hyperdiploidy Pseudodiploidy
t(9;22)
t(8;14)
t(4;11)
t(14q+)

21. TREATMENT OF ACUTE LEUKAEMIAS
General Supportive Treatment:
Blood products support to treat anaemia and
thrombocytopenia.
 Antibiotic coverage to treat infections.
Insertion of central venous catheter (Hickman) via a
skin tunnel from the chest into the superior vena cava to
give access for giving chemotherapy , blood products,
antibiotics, intravenous feeding, etc.
 Prevention of vomiting.