categorized into acute leukaemia and chronic leukaemia. 19.1 Introduction Acute leukaemia is characterized by the presence in the bone marrow and/or peripheral blood circulation of immature cells (blast or promyelocytes). Lymphoblasts are found in acute lymphoblastic leukaemia (ALL) while myeloblasts are found in acute myeloid leukaemia (AML). Both myeloblasts and promyelocytes are found in a subset of AML knowns as acute promyelocetic leukaemia (APML). All have aggressive biological behavior with rapid progression to fatality if not properly treated. 19.2 Epidemiology Even though acute myeloid leukemias (AMLs) are infrequent they are highly malignant yet curable in a sizeable proportion of cases it treatetes d appropriately making them significant in clinical practice. AML shows 2 peaks in occurrence, one in early childhood with the majority occurring later in adulthood. ALL is on the other hand most common in childhood with a peak incidence at 2–5 years of age, with a smaller peak in old age. There is a slight male preponderance in both AML and ALL. 19.3 Diagnosis Patients with the following symptoms (history) should be further evaluated ¡5KZXjggZci5^c[ZXi^dch ¡57aZZY^c\5dg5ZVhn5Wgj^hVW^a^in ¡5NcZmeaV^cZY5PZ^\]i5adhh5 ¡59gZcX]^c\5c^\]i5hlZVih ¡5IZgh^hiZci5[ZkZg ¡57dcZ5eV^ch The following clinical signs should be looked for in a full physical examination: ¡5IVaadg5=VcVZb^V> ¡5LeaZcdbZ\Van5 ¡5AZeVidbZ\Vaan ¡57gj^h^c\5=ejgejgV> ¡[email protected]]neZgigde]n ¡5Enbe]VYZcdeVi]n5=6aa5\gdjeh5d[5anbe]5cdYZh>
National Guidelines for Cancer Management Kenya 109 19.3.1 Laboratory Evaluation ¡57dcZ5FVggdl56he^gViZ5=bVcYVidgn>5VcY5igZe]^cZ5=gZXdbbZcYZY>5[dg5Y^V\cdh^h!55 5 with relevant cytochemistry and immunophenotyping as applicable. ¡5?78!5l^i]5Y^÷ZgZci^Va5Xdjci5VcY5eZg^e]ZgVa5WaddY5Ñab5ZmVb^cVi^dc ~ Where the blood count is abnormal, or there are abnormal cells are seen on peripheral film, the slides must be reviewed by a specialist pathologist (haematopathologist or clinical pathologist with haematology experience) ~ Stained slides and unstained slides should be prepared at site and sent with the whole blood to the pathology laboratory for review, if initially reported by a technologist only ¡5M]Z5[daadl^c\5VcX^aaVgn5iZhih5VgZ5gZXdbbZcYZY5l]ZgZ5edhh^WaZ/5Òdl5XnidbZign$55 immunophenotyping and cytogenetics/molecular studies are recommended for establishing sub-type of acute leukaemia for purposes of risk stratification and prognostication. 19.4 Staging and Risk Assessment ¡57^dX]Zb^hign5^cXajY^c\5a^kZg5VcY5gZcVa5[jcXi^dc5iZhih!5Va`Va^cZ5e]dhe]ViVhZ5=6EI>!555 lactate dehydrogenase (LDH), urate, and liver enzymes. ¡5O^gVa5hZgdad\n5[dg5ABO5=bVcYVidgn>!5AZeVi^i^h575VcY5AZeVi^i^h585=higdc\an555 5 recommended). ¡59^V\cdhi^X5iVe5=EjbWVg5ejcXijgZ>5^h5bVcYVidgn5[dg5Vaa5eVi^Zcih5l^i]56EE!5VcY55 5 is recommended for other acute leukaemias with clinical suspicion of CNS involvement.
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