1. LEUKEMIA CASE

2. 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

3. 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

4. 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

5. ACUTE MYELOID LEUKEMIA M5
AUTE MONOCYTIC LEUKEMIA AML M5

6. 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

7. 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%

8. Diagnosis
M5b

9. 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

10. PBS

11. BM asp

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. 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 .

21. 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

22. Thank you