1. STUDY ON FEATURES OF CLINIC, BIOCLINIC AND DIAGNOSIS THE SUBTYPE OF ACUTE LEUKEMIA IN VIETTIEP FRIENDSHIP HOSPITAL,
Dr: Pham Thi Loc
Hematology and blood transfusion department
Hai Phong University Medicine and Pharmacy

2. Introduction
Acute leukemia (LA) is a group of malignant conditions of hematopoietic system with two common types, namely acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL).
The treatment is very difficult and proportion of failure is too high. The accurate typing of the disease can improve survival proportion.
HP used technique cytochemical staining to confirm the type of AL more exact. NIHBT used to immunophenotyping and cytogenetics to determine subtype of AL 1

3. Objectives of the study
Describe the characteristics of clinic, bioclinic and diagnosis of AL in Viettiep Friendship Hospital,
Determine subtype of AL following the classification of F.A.B in these cases.

4. 1. Location and time of research
Materials and methods
1. Location and time of research
Hematology department in VietTiep Friendship Hospital from 1/ / 2016.
2. Selected criterion:
Diagnosis with Blast ≥ 30% in bone marow
3. Sample: convenient, not probable
Chose 102 patients with group retrospective: 71 cases and group prospective: 31 cases
4. Study design: retrospective and prospective processes
5. Data processing: SPSS 20.0

5. 6. Diagnostic criterion on this research Diagnosis anemia: WHO 2012
Materials and methods
6. Diagnostic criterion on this research
Diagnosis anemia: WHO 2012
Diagnosis infection: WHO 2012
Diagnosis AL: F.A.B and WHO 2001
Diagnosis subtype of AL: F.A.B and WHO 2001

6. results and discussion
1. Characteristics of clinic and bioclinic of patients Table 1: the rate of patients with ages
age
n = 102
Percentage
≤ 30
 19
 18.6
30- 39
 11
 10.8
40- 49  8
 7.8
50- 59
 27
 26.5
60- 69
 10
 9.8
≥ 70
Mean age
 53.5 ± 19.9
N.T.M.An(1998): age > 60t =25% Đ. H. Anh(2006): age> 50t = 12.3%

7. results and discussion
Table 2: rate of patients with age and sex
Group ages
male
female n %
< 30 14
22.6 5
12.5
30 – 39 7
11.3 4
10.0
40 – 49 3
4.8
50 – 59 16
25.8 11
27.5
60 – 69 8
12.9 2
5.0
≥ 70 13
32.5
total 62
100% 40
100
X ± SD
51.5 ± 20.1
56.6 ± 19.3

8. results and discussion
Table 3: priciple clinical symptoms
prognostic
Number of patient (n=102)
Percentage
Fatigue, anemia 90
92.8
Petechia 47
48.5
fever 44
45.4
Bone pain 21
21.6
N.T.L.Hương (2013) anemia:82.9% petechia :50.7%, infection: 58.3% bone pain: 9.8%. N.T.Hải(2010) anemia: 88.7%, petechia : 59% inf: 62% bone pain: 11.3%

9. results and discussion
Table 4:clinical symptoms liver, spleen, lymph node
Clinical signs
n = 102
Percentage
Enlarged liver 15
14.7
Enlarged spleen 43
42.2
Enlarged node 32
32.4
Enlarged liver and spleen 5
4.9
Enlarged liver and node 7
6.9
Enlarged spleen, node 13
12.8
Enlarged liver, spleen, node
D.H.Anh (2006) liver: 26.2% spleen: 18.5% lymph node: 27.7%
N.T.L.Hương (2013) liver: 22.0% spleen: 19.5% node: 14.6%

10. results and discussion
Chart 1: anemia’s level on clinic
1: minor level
2: medium level
3: major level

11. results and discussion
Table 5: some blood tests
test
unit
X ± SD
Min
Max
GOT
U/l
45.5 ±77.7
10.0
608.0
GPT
42.1±77.4
5.0
605.0
Ure
mmol/l
5.6±0.2
2.5
12.8
Creatin
Mmol/l
87.6±3.5
56.0
395.0
Ca++
2.4±0.2
1.6
2.80
K +
3.6±0.1
2.1
4.8
Glucose plasma
6.1±0.2
2.9
17.4
N.T.T.Hải (2010) GOT: 81,1±128, GPT: 51.6± 118.6, ure: 6.6±4.6, cre: 73.2±21.8, Ca++: 2.2± 1.2 K+: 3.8± 21.8, glucose: 6.6±4.6

12. results and discussion
Table 6: basic coagulation tests
tests
decrease
normal
rise(kéo dài) p
Number of patient % PT 48
47.1 54
52.9
<0.05
APTT 3
2.9 83
81.4 16
15.7
Fib 8
7.8% 82
80.4 12
11.8
N.T.L.Hương (2013) PT decrease: 43.9% APTT rise: 19.5%, FIB low: 12.2%

13. results and discussion
Table 7. Hemoglobin concentration in peripheral blood
Hemoglobin ( g/l )
n = 102
Percentage
≤60 10
9.8
61- 80 37
36.3
81-100 36
35.3 15
14.7
>120 4
3.9
Mean Hemoglobin
83.6± 15.7
N.T.L.Hương (2013) hb trung bình: 76.7±18.5 min: 45, max: 118g/l

14. results and discussion
Table 8: number of WBC in peripheral blood
WBC (giga/ lit)
n = 102 %
< 4 12
11.8
4- 10 17
16.7
10,1- 100 53
52.0
> 100 20
19.6
Mean of WBC
62.5 ±128.1
N.T.L.Hương(2013) mean WBC:44.3 ± 81.7 min: 0.5 max: 359

15. results and discussion
Table 9. number of platelet in peripheral blood
platelet (Giga/ lít)
n =102
Percentage
≤ 20 16
15.7
21- 50 33
32.4 36
35.3 7
6.9 8
7.8
>450 2
2.0
Mean of platelet
60± 54.2
N.T.L.Hương (2013) mean of platelet: 32 ± 43.7 min: 5 max: 104 G/l

16. results and discussion
Chart 2: proportion of blast in peripheral blood
N.T.L.Hương (2013) mean of blasts: 43.6± 34.4 min: 0% max: 95%

17. results and discussion
Table 10. number of bone cells
Bone cell (Giga/lít)
n = 102
percentage
< 30 14
13.7 18
17.6
> 100 70
68.6
Mean of bone cell
218.9 ± 177
N.T.L.Hương (2013) mean of bone cell: ± 169, min: 10G/l, Max: 678.5G/l

18. results and discussion
Chart 3: proportion of blasts in bone marrow
N.T.L.Hương (2013) mean % blasts in bone: 66.1 ± 18.6 min: 30% max: 92%
We are: % blasts in bone: 65.9 ± 20.4 min: 29.5% max: 96%

19. results and discussion
Table 12. proportion of reticulocyte in bone marrow and peripheral blood.
reticulocyte
X ± SD
Min(%)
Max(%)
reticulocyte in peripheral blood
1.0 ± 0.4
0.3
1.3
reticulocyte in bone marrow
0.4 ± 0.2
0.2
0.7
N.T.L.Hương (2013) % HCl máu: 0.4% ± 0.5%, min: 0.1% max: 1.1%, % HCL tủy TB: 0.4% ± 0.3%, min: 0.1%, max: 0.9% 1

20. results and discussion
Chart 5. Classification of AML with morphology
n1= 58
n2= 23
p<0.05
N.T.M.Hương(2013) M0: 2.4%,, M1: 12.2%, M2: 36.6%, M3: 2.4%, M4: 24.4%. M5:19.6%, M6: 2.4%, M7:0%

21. results and discussion
Chart 6. Classification of ALL with morphology
n1=13
n2=8
p>0.05
P.Q.Vinh (2006) L1: 18.5%, L2: 74.5% L3: 7.0%

22. results and discussion
Table13: classification of AL with cytochemical staining
Cytochemical stain
Sudan black
Perosidase
PAS
Esterase
Total of patient M1 + - 1 M2 ++ 10 M3
+++ 4 M4 5 M5 3 L1 L2
Total 31

23. results and discussion
Table14: classification of AL with immunophenotyping and cytogenetics (NIHBT)
Subtype
Immuno phenotype
cytogenetic
Total of patient M1
CD 13, CD 33
t(9,11) 1 M2
CD 13, HLA-DR
t(8,21) 10 M3
CD 15, CD 33
t(15,17) 4 M4
CD 11b, CD 33
+21, +22 5 M5
+8,11q23 3 L1
TdT, CD19
t(9;22) L2
CD3, CD7
Total 31

24. conclusion
Characteristic clinic: male/female: 2:1, highest age group with AL >70t.
92.8% anemia, 45.4% infection and 48.5% petechia.
Characteristic peripheral blood test: mean of Hb: 83.4± 19.0g/l, platelets: 79.4± G/l , WBC: 62.5± 89.4 G/l, percentage of blood blast: 54.3± 25.2 %.
Characteristic of bone marrow test: number of bone cell: ± G/l. percentage of blast in bone marrow: 65.9± 20.4%.

25. conclusion Result of classification of AL in research
In group 1(n= 71): M2= 21.6%, M3= 13.7%, M0, M6, M7 =0%, 19.6% AML not confirm subtype. L1=14.3%, L2= 47.6%, L3=0%, 38.1% patients didn’t confirm subtype.
In group 2(n = 31): M2=32.3%, M3 =12.9%, L1= 37.5%, L2= 62.5% .M0, M6, M7,L3 =0%, number of patient didn’t confirm subtype = 0%.

26. Thanks for your attention!