Acute myeloid leukemia • Malignant clonal disorder of immature hematopoietic cells characterized by abberant hematopoietic cellular proliferation and maturation. Leukamic blasts may express capabilities for maturation to a variable degree, which lead to morphological
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Acute myeloid leukemia Malignant clonal disorder of immature hematopoietic cells characterized by abberant hematopoietic cellular proliferation and maturation.
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Acute myeloid leukemia
• Malignant clonal disorder of immature hematopoietic cells characterized by abberant hematopoietic cellular proliferation and maturation. Leukamic blasts may express capabilities for maturation to a variable degree, which lead to morphological heterogeneity
• Monocytic cells > 20% of nonerythroid cells and confirmed
by cytochemistry or elevated urinary lysozyme
• Marrow resembling M2, but blood monocytes > 5x109/l and
confirmed by cytochemistry or elevated urinary lysozyme
Positive for SBB, POX, chloroesterase (granulocyte lineage)
+ -naphtyl esterase (monocyte lineage)
Cytological criteria for the diagnosis of acute myeloid leukaemia:
French-American-British (FAB) classificationFAB
subtypeMicroscopy Cytochemistry
/ Immunology
M5A
Acute monoblastic leukaemia
• Blasts 30% of bone marrow nonerythroid cells
• Bone marrow monocytic component > 80% of nonerythroid cells
• Monoblasts > 80% of bone marrow monocytic component
M5B
Acute monoblastic
monocytic leukaemia
• Blasts 30% of bone marrow nonerythroid cells
• Bone marrow monocytic component > 80% of nonerythroid cells
• Monoblasts < 80% of bone marrow monocytic component
Cytological criteria for the diagnosis of acute myeloid leukaemia:
French-American-British (FAB) classification
FAB subtype Microscopy Cytochemistry/ Immunology
M6
Acute erythro- leukaemia
• Erythroblasts > 50% of bone marrow
nucleated cells
• Blast >30% of bone marrow non
nonerythroid cells
Glycophorine A positivity
M7
Acute megakayoblastic
leukaemia
• Blasts 30% of bone marrow nucleated
cells
Blasts demonstrated to be megakaryoblasts by immunological markers, ultrastructural morphology or cytochemistry
Acute myeloid leukemia Clinical features
• Suddent onset of the disease and very fast progression
• If not treated death after a few months
• Most of the common systemic manifestations, such a fatigue, weakness, fever and weight loss, are non-specific
• Infiltration of bone marrow by leukemic cells supression of normal hematopoietic progenitor cells
growth granulocytopenia, thrombocytopenia and anemia
- infection of skin, mucous membranes, gums, respiratory, GI and GU tracts
- bleeding in skin, mucous membranes, gums, GI and GU tracts
- fatigue, weakness
Acute myeloid leukemia Clinical features
• The prevalence and degree of organ infiltration vary somewhat with the different types of leukemia
- abdominal fullness (enlargement of the liver and spleen)- gum hypertrophy (AML-M4 and M5) - bone and join pain and tenderness - neurological symptoms: headache, nausea, vomiting, blurred
vision, cranial nerve dysfunction (AML-M4 and M5)- DIC (AML-M3)
Acute myeloid leukemia Clinical features
Acute myeloid leukemiaApproximate frequency of organ infiltration
Organ Percent on initial exam Percent at autopsy
Lymph nodes
Liver
Spleen
Bone and joint
Lungs
Heart
CUN
GI
10
40
35
2
5
2
1
-
50
90
90
5
50
35
27
10
Acute myeloid leukemia
• The diagnosis of AML is primarily based on morphological (< 30% of basts and suppression of other lineages) and cytochemical criteria
• Immunophentyping, cytogenetic analysis and molecular examination are employed to add specific information for a more precise diagnosis (e.g. to identify undifferentiated leukemias as being myeloid)