Acute Leukaemia

As always, check out the Calgary Guide for the pathophysiology of leukaemias. The important thing to realise is that Chronic Myeloid Leukaemia (CML) can progress into AML or ALL.

Chronic Myeloid Leukaemia

Incidence of 1 per 100 000 population. Symptoms are usually chronic and non-specific, but splenomegaly is common and may extend beyond the umbilicus. Lymphadenopathy is not usually prominent. Neutrophilia is common and may be accompanied by thrombocytosis, basophilia, monocytosis, or eosinophilia.

Acute Leukaemias

Acute Lymphoblastic Leukaemia
Rare
Common at 2-10 years with a peak at 3-4 years
Secondary rise after 40 years
Acute lymphoblastic leukaemia is slightly more common among males than females

Acute Myeloid Leukaemia
10-15% of childhood leukaemia but is the commonest leukaemia of adulthood
Incidence increases with age, and the median age at presentation is 60 years.
Acute myeloid leukaemia is equally common among males and females

General
Clinical Features
Bone Failure - signs of anaemia.
  neutropenia - infections of the mouth, throat, skin or perianal region
  thrombocytopenia - spontaneous bruising, menorrhagia, bleeding from venepuncture sites, gingival bleeding or prolonged nose bleeds
Organ infiltration
“B symptoms”- fevers, night sweats, and unexplained weight loss

Investigations
- Anaemia - normocytic
- Low platelets
- Low white cell count - neutropenia with lymphocytosis
- Coagulopathy
- Hyperuricaemia
- Chest radiography is mandatory to exclude the presence of a mediastinal mass

References
http://calgaryguide.ucalgary.ca/slide.aspx?slide=Overview%20of%20blood%20cell%20malignancies.jpg
http://calgaryguide.ucalgary.ca/slide.aspx?slide=Pathophysiology%20behind%20the%20leukemias.jpg

http://www.bmj.com/content/346/bmj.f1660?sso=

Chronic Lymphocytic Leukaemia

There are two types of "chronic" leukaemia. The pathophysiology and clinical features are different - so I'll look at CLL to start with. As always, the Calgary Guide has the best overview. 

Epidemiology

- 3/4 of patients are > 55 years old

- Less than 2% are younger than 45 years old. 

- >20 per 100,000 over 70 years old

- Twice as common in men as women

- Most common in Western White and black populations

- Strongest risk factor is FHx 

Small Lymphocytic Lymphoma

- Same disease, but in the lymph nodes rather than the blood.

Clinical Features

-  80% are asymptomatic

- Painless, often symmetrical lymphadenopathy, splenomegaly, or hepatomegaly. 

- In the latter stages of the disease patients may have anaemia, neutropenia, or thrombocytopenia due to bone marrow failure. 

Investigations

- Raised lymphocytes (lymphocytosis)

- Classified by Rai and Binet systems. 

Treatment

- To slow progression, and for palliation. 

Complications

Infections - bacterial, and viral

Anaemia - bone marrow suppression, or secondary to autoimmune haemolytic anaemia, red cell aplasia, 

Bleeding - bone marrow suppression or immune thrombocytopenia

Transformation- Richter's transformation into CLL. Symptoms of weight loss, fevers, night sweats, muscle wasting, and increasing hepatosplenomegaly and lymphadenopathy. 

References

http://learning.bmj.com/learning/module-intro/chronic-lymphocytic-leukaemia.html?locale=en_GB&page=1&moduleId=10030509&searchTerm=%E2%80%9Cleukaemia%E2%80%9D

http://calgaryguide.ucalgary.ca/slide.aspx?slide=Chronic%20Lymphocytic%20Leukemia.jpg