LEUKEMIA CASE

Patient is 47 years old from Indonesia Patient came to the hospital in conscious and complained to have body weakness ,body ache and right leg numbness He was reported with no fever ,bruise under skin and malaise Patient was taken for other physical examination : Fundoscopic examination –normal Mouth & gum –no gum hypothrophy Heart –dual rhythm ,no murmur Lung – clear Skin mucosa-bruise at right gluteal region Viral study –hep B,C HIV –negative

Doctor reguested for full blood count ,renal profile ,lipid profile and peripheral blood film Full blood count result showed a very high reading for total WBC, monocyte and large immature cell Meanwhile a very low reading for platelets For PBF red cells shows with anisopoikilocytosis Red cell count found to be very low For white cell reveals marked leukocytosis with plenty of leukemia cells which mainly composed of monoblast Platelets count is markedly low with no clumping seen Patient was advised to have bone marrow study and immunophenotyping

For BM aspirates ,many blast cells seen on smear For BM aspirates ,many blast cells seen on smear .these cell are large with round –shaped nuclei and lycy chromatin The differential count shows : Monoblast-87% Neutrophil-5% Lymphocyte -4% After all tests and BM procedure carried out ,patient underwent chemotherapy session and also twice blood transfusion durig the session

ACUTE MYELOID LEUKEMIA M5 AUTE MONOCYTIC LEUKEMIA AML M5

Blasts are of heterogenous morphology 42years old male patient presented with anemia,thrombocytopenia and leukocytosis B.M aspiration report; hypercellular marrow showing massive infiltration by leukemic cells Blasts are of heterogenous morphology Monocytic compound constitutes around 85% of the total hematopoiesis with monoblast making around 60% of them large

They show lobulated nucleus open chromatin multiple nucleoli ,basophilic,vaculated cytoplasm and have no auer rod Amixture of monocytes and promonocytes are also present Myeoblast constitute about 5% of the total hematopoiesis Eosinophil precursor appear prominent 6%

Diagnosis M5b

38 years /M ,Egyptian Bodyache ,fatigue,he noticed jaw fullness Indonesion ,dental infection ,gum hypertrophy WBC:194.57 HB:13.2 PLT:78.000 Numerous monoblast BM is infiltrated by mononuclear immature cells (monoblasts and promonocytes 78%) Immunophenotyping :positive CD 34,117,33,99,56 Negative CD2,5,19,41,61 MPO and TdT DIAGNOSIS : M5a

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WHAT IS LEUKEMIA Is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called “blast” Acute monocytic leukemia is a distinct rare subtype of acute myeloid leukemia (AML) with characteristic biologic and clinical features

CLASSIFIVATION According to FAB classification: Acute myeloid leukemias divided into subtypes M0 through M7 TODAY WE SPEAK ABOUT M5 which 10%of adult AML patient

PHATHOGENESIS M5 is associated with characteristic chromosomal abnormalities ,often involving chromosome 11 at 11q23 such as t(9:11)(p22:q23),t(10:11)(p13:q23),t(11:19) and other affecting the MLL locus The disease is associated with hyperleukocytosis ,extramedullary involvement ,hemophagocytosis and coagulation abnormalities including disseminated intravascular coagulation

Differential DIAGNOSIS AML-M5 is defined by more than 30% of myeloblasts in the BM aspiration BM monocytic cells comprise more than 80% of non –erythroid cells The percent of monoblasts in monocytic cells determine the sub –type of AML-M5: More than 80% its AML-M5a Less than 80% its AML-M5b

SIGN AND SYMPTOMS Bleeding problems from thrombocytopenia : Epistaxis-oral or gingival bleeding -Rectal blood loss Menorrhagia cerebral hemorrhage Swollen lymph glands in : 1-abdominal 2-under arms 3-groin 4-neck

Fatigue and fever Susceptibility to infection Abnormal bruising Bone and joint pain Enlarged spleen and liver Weakness, weight loss and loss of appetite Shortness of breath when exercising Petechiae Excessive sweating –especially at night

Laboratory diagnosis Routine blood analysis shown a normocytic , normocromic anemia with adecreased number in reticulocyte and thrombocyte (more 100,000/ml While WBC is high but sometimes is low Blood chemistry analysis should include plasma electrolytes ,uric acid ,acetate dehaydrogenase,creatinine and blood urea nitrogen

TREATMENT AML-M5 is treated with intensive chemotherapy such as Anthracyclines )) Or with bone marrow transplantation

Prognosis Leukemia treatment has improved over the years , so research has focused on why some patients have a better chance to be cured than others . The AML suptype certainly plays a role in this Other differences among patients that affect response to treatment are called Prognostic factors They help doctors decide if people with a certain type of leukemia should receive more or less treatment .

Prognostic factor 1-the cytogenetic test results (showing chromosome or gene changes) 2-the patients age ,and the WBC count 3-pre-existing blood disorders (such as a myelodysplastic syndrome ) 3-history of treatment with chemotherapy and /or radiation therapy for an earlier cancer

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