Leukemia is a cancer of the blood cells that occurs when bone marrow produces abnormal white blood cells. There are four main types of leukemia - acute lymphocytic, acute myeloid, chronic lymphocytic, and chronic myeloid leukemia. Symptoms can include fatigue, fever, joint pain, and easy bruising. While the exact causes are unknown, risk factors include genetics, radiation, chemicals, and certain infections or diseases that affect the immune system.

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DR MJ LASHARI
PHARMACY-PHARM-D
UNIVERSITY OF SINDH
JAMSHORO
SINDH PAKISTAN

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Leukemia
CONTENT
 Introduction of leukemia
 pathophysiology of leukemia
 Types of leukemia and their differences .
 Symptoms
 Etiology or (causes of leukemia )

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INTRODUCTION OFLUKEMIA
Leukemia is a broad term for cancers of the blood cells. The type of leukemia depends on
the type of blood cell that becomes cancer and whether it grows quickly or gradually .
Leukemia occurs most often in adults older than 55 age but it is also the most common
cancer in children younger than 15 year age .
Definition:
Leukemia are neoplastic proliferative disorder of white blood cells (WBC’s).
OR
Leukemia is a malignant hematologic disorder characterized by a proliferation of
abdominal white blood cell (WBC) that infiltrate the bone marrow, peripheral blood and
organs.
OR
Leukemia is a type of cancer found in your blood and bone marrow and is caused by the
quick production of abnormal white blood cells.(WBC”s)
These abnormal white blood cells are not able to fight infection and impair the ability of
the bone marrow to produce red blood cells and platelets.
PATHOPHYSIOLOGY OF LUKEMIA
As with many malignancies, the precise aetiology of childhood leukemia remains idiopathic
unknown cause .
It is clearly a multi-factorial condition, with infection, genetic predisposition and numerous
environmental exposures all playing a potential role in development of leukemia .
Disruptions or disarranging in the regulation and proliferation of lymphoid precursor or
stem cells ( B and T cells ) the bone marrow leads to excessive or uncontrolled production
of immature “blast or myeloblasts” cells. and a subsequent drop in numbers of functional
red blood cells (RBC’s) white blood cells (WBC’s and platelets (thrombocytes)

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In Children with certain genetic diagnoses, such as Down syndrome trisomy 21, are known
to be at increased risk of leukemia Down syndrome (trisomy 21) : it is genetic disorder
in which extra copy of chromosomes build, how the baby body and brain develop which
can cause both mental and physical challenges for the baby.
diagramically representation pathogenesis of leukemia
TYPES OF LEUKAMIA
The four most common types of leukemia are :
1: Acute lymphocytic leukemia (ALL)
2: Acute myeloid leukemia (AML)
3: Chronic lymphocytic leukemia(CLL)
4: Chronic myeloid leukemia (CML)
Acute lymphocytic leukemia( ALL)
Acute lymphocytic leukemia accurse in more common in children.

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This type of leukemia begins in the B or T lymphocytes, which are immature white blood
cells (WBC’s)
Lymphocytes are the building blocks of the lymphoid tissues that make up the immune
system.
Acute lymphocytic leukemia can affect the bone marrow all over the body, it also spread to
lymph nodes , liver, and spleen
Acute myeloid leukemia (AML)
AML is the most common type of acute leukemia in adults.
It tends to progress rapidly . It can affect any component of the blood and there are many
subtypes of Acute myeloid leukemia .
Blood stem cells in the bone marrow form into either lymphoid cell become white blood cell
and myeloid cell become red blood cell white blood cells or platelets .
and In Acute myeloid cell myeloid stem cells usually mature into abnormal myeloblasts,
or white blood cells.
But, they sometimes become abnormal red blood cells or platelets.
As they multiply, they overwhelm the normal cells in the bone marrow and blood.
The cancer cells can also spread to other parts of the body.
Chronic lymphocytic leukemia (CLL)
CLL accounts for about a third of leukemia diagnoses. It usually affects older adults.
One form of Chronic lymphocytic leukemia progresses gradually ,Symptoms may not
appear until years after onset.
Another form of Chronic lymphocytic leukemia grows very quickly.
Chronic lymphocytic leukemia begins in the B lymphocytes. As the abnormal cells
proliferate, they crowd out the normal cells.
More subtypes of Chronic lymphocytic exist that affect other types of cells.
Chronic myeloid leukemia (CML)
This type of leukemia is rare. Only ten percent of leukemias are Chronic myeloid leukemia .
Adults are more likely than children to get Chronic myeloid leukemia.

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Chronic myeloid leukemia occurs when a genetic change turns the myeloid cells into
immature cancer cells. These cells then grow slowly and gradually and overwhelm or
submerge the healthy cells in the bone marrow and blood, A subtype of CML can form
very quickly. This type is hard to treat.
Acute lymphocytic leukemia ______________________________Chronic lymphocytic leukemia
Acute lymphocytic leukemia mostly in most form of chronic lymphocytic
Found in children male >females . leukemia there is clonal proliferation of
Cytochemical staining B”lymphocytes and occasionally T”lymph
Sudden block and myeloperoxidase negative CLL is move often found in older persons
And usually non specificstrase negative. >60 years more in males effected WBCs
PAS , periodic acid strain is often positive . counts rise 50-200X109/l Hb moderately
PAS and NSE WBCs count rise in 15-100x109/l, low N/N platelets low in late stage blood
Hb lower N/N, platelets . film shows absolute lymphocytosis small
Classification (L1-L3). Lymphs with coarse chromatin , smear cell
are seen
Hypercellular with lymphoblasts hyper cellular with mature small lymphs and
large
and lymphocytes . large lymphoid cell lymphos make up 25 -90%
of all
the cells .

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Acute myeloid leukemia _________________________________Chronic myeloid leukemia
AML is usually more common in adults . in CML there is proliferation of myeloid
The finding of Auer rods in blast cells cells . the abnormal Philadelphia chromosome
Is diagnostic of acute myeloid leukemia is present in the leukemia cells of more then 90%
Cytochemical staining of patients with chronic myeloid leukemia
Sudden block myeloperoxidase CML is more common in younger people and children
positive PAS negative monoblasts WBC’s count 50-500X109/L, Hb down N/N, platelets
are strongly positive for NSE. Rise in about 30% of patients or normal or low .
WBC’s count rise 15-100X109/L Blood film exhibit neutronphils predominates marked,
Hb lowN/N platelets low , blast cells left shift with metamyelocytes,myelocytes
present Auer rods may be seenin promyelocytes seen.
myeloblasts, rest of myeloid cells often easinophils ,basophils rise hypercellular
may be morphological abnormal . with mature and immature myeloid cells less then
myeloblast predominate. FAB 5% blast cells .
classification (mo-M7).
SYMPTOMS OF LEUKEMIA
 Psychological
 Fatigue
 Loss of appetite
 Lymph node swelling
 Weight loss , fever

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 Shortness of breath , muscular weakness bone joints pain tenderness
 Easy blooding during brushing
 Spleen or liver enlargement night sweats etc .
ETIOLOGY OR CAUSES OF LEUKEMIA
There is no exact causes of leukemia, It seems to develop from a combination of genetic
and environmental factors.
In general, leukemia is thought to occur when some blood cells acquire mutations in their
DNA — the instructions inside each cell that guide its action.
 Heredity
 Environmental factor ( ionizing radiation , such as X_rays , Gama Rays ultra
violet ), chemical carcinogens like as smoking cigrates tobaccos etc.
 certain drugs. melphalan, thio-TEPA, chlorambucil, , cyclophosphamide .
and oxidant free radicals also risk factor of leukemia cancer .
 Infections human T cells leukemia lymphoma virus 1(HTLV 1 )
 Association with disease of immunity immunodeficiency disease like AIDS (HIV)
iatrogenic immunosuppressant induced by chemotherapy or radiation .