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Medicine

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Hematology

Question
7 out of 16
 

The most common type of ALL is:



A Pre B cell ALL
B T cell ALL

C B cell ALL
D Biphenotypic ALL

Ans. A Pre B cell ALL

Leukemias

Leukemias are malignant neoplasms of the hematopoietic stem cells, arising in the bone marrow, that flood the circulating blood or other organs.

Acute Lymphocytic Leukemia (ALL) (Ref. Hari- 18th ed., Pg. 919)

ALL (Working Classification)

L1 Small round blasts with scanty cytoplasm

L2 Pleomorphic larger blasts with more cytoplasm and prominent nucleoli

L3 Vacuolated cytoplasm with vesicular nuclei.

Clinical Features

1. ALL is common in children

2. AML in middle – aged.

3. Onset is abrupt and stormy, and patients present within 3 months of the onset of symptoms.

4. Fatigue, anemia, fever (due to infection), bleeding episodes (petechiae, ecchymoses, epistaxis, gum bleeding, fundal haemorrhage) secondary to thrombocytopenia;

5. Bone pain and tenderness due to marrow involvement and subperiosteal bone infiltration are seen.

6. CNS involvement is due to leukemic infiltration of the meninges, resulting in headache, vomiting, papilledema, cranial nerve palsies etc.

7. ALL presents with hepatosplenomegaly and lymphadenopathy.

8. Patients are prone to super impose infection by bacteria, HZV, CMV, measles, candidiasis, pneumocystic carinii

Extra Edge:Pathology of ALL

1. ALL blasts do not contain azurophilic granules

2. ALL blast contain PAS positive material.

3. Terminal deoxy transferase (TdT) is present in 95% cases.

Classification of Acute lymphoid leukemia (ALL)

Immunologic Subtype

% of Cases

FAB Subtype

Cytogenetic Abnormalities

Pre-B ALL

75

L1, L2

t(9;22), t( 4, 11) (Common below 12 months of age), t(1; 19), t(12; 21) (Most common)

T Cell ALL

20

L1, L2

14q 11 or 7q34

B Cell ALL

5

L3

t(8; 14), t(8; 22), t(2;8)

Immunophenotypic Classification for ALL

FAB

classification

Immunologic

classification

Phenotype

Pre-B Cell

Early Pre-B

CDI9, CD20-/+, CD10, CD34, TdT

Pre-B

CDl9, CD20+/-, CD10, CD34-, clgM, Tdt+/-

B cell

B cell

CDl9, CD20, CD22, CD10+/-, CD34-, Tdt-, sIg

T cell

T cell

CD1, CD2, CD3, CD5, CD7, CD10+/-, CD34-/+, Tdt, dual CD4/CD8

Pre B-cell ALL are the commonest types of Acute Lymphoblastic leukemias and account for upto 75% of all ALL

Investigations

1. Anemia (normal or raised MCV)

2. WBC count: 50,000 – 100,000/μL

3. Blood film: Shows blast cells and other primitive cells

4. Bone marrow examination: Hypercellular bone marrow with blasts replacing normal cells to varying degrees (30% or more)

5. Presence of larger blasts, lower nuclear – cytoplasmic ratio and Auer rods in the cytoplasm of blast cells indicate a myeloblastic type of leukemia

6. Thrombocytopenia and spontaneous bleeding, especially with platelet count (20,000/μL)

Hematology Flashcard List

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