1. Chronic leukemia 1

2. Chronic Lymphocytic leukemia (CLL) * Definition: Chronic neoplastic disorder characterized by accumulation of small mature-looking lymphocytes which are immunologically immature in blood, bone marrow and lymph nodes. It is of B-cell type. The cells accumulate in the bone marrow, blood, liver, spleen and lymph nodes. Characterized by chronic persistent of lymphocytosis. Chronic Leukemia 2

3. * Clinical features of CLL: 1- The disease occurs in older patients (> 50 years old). 2- Total leukocytic count: exceeds 200.000/mm3 with absolute lymphocytosis. 3- (Generalized lymphadenopathy): enlargement of cervical, axillary or inguinal lymph nodes 4- Hepato-splenomegaly occurs in 50-60% of cases. 5- Features of anemia may be present. 6- Bruising or purpura may occur due to thrombocytopenia. 7- Immunosuppression is a significant problem. - Bacterial infections followed by viral and fungal infections such as herpes zoster are also seen. Chronic lymphoid leukemia 3

4. . 4 Cervical lymphadenopathy Herpes zoster infection

5. * Laboratory findings of B-cell CLL: 1- Peripheral blood: WBCs: Absolute lymphocytosis (↑↑↑ >100.000) Morphology: - Small mature looking lymphocytes - Dense chromatin - Small rim of cytoplasm RBCs: Normocytic normochromic anaemia is present in later stages. Platelets: ↓. 2- Bone marrow: shows lymphocytic replacement of normal marrow elements (> 40%) 3- L.N.: Diffuse infiltration by mature looking lymphocytes. 4- Immunophenotyping: cells express CD5 (+ve in 90% of cases) Pan B markers +ve: CD19, CD20, CD22 Chronic lymphoid leukemia 5

6. 6 CLL: This peripheral blood smear is flooded with small lymphocytes with condensed chromatin and scant cytoplasm. A characteristic finding is the presence of disrupted tumor cells (smudge cells).

7. Chronic Myeloid leukemia (CML) * Definition: - It is a neoplastic proliferation of the pluripotent hematopoietic stem cell. - The main feature is the presence of Philadelphia chromosome (Ph) which occurs due to t(9,22) translocation. Chronic Myeloid Leukemia 7

8. 8 * Clinical features of CML: 1- Affects adults between 25-60 years. 2. Symptoms related to hyper-metabolism due to increased cell turnover (e.g.weight loss, anorexia, night sweats). 3- Huge Splenomegaly and splenic infarction may occurs. 4- Features of anemia may include pallor, dyspnoea and tachycardia. 5- Gout or renal impairment caused by elevated levels of uric acid may be a problem. 6- In up to 50% of cases the diagnosis is made incidentally from a routine blood count.

9. * Lab findings in CML: 1. Peripheral blood: * WBCs: >100.000 - Predominantly of neutrophils, metamyelocytes and myelocytes exceed those of blast cells and promyelocytes - Increased circulating basophils and esinophils. * RBCs: Normocytic normochromic anaemia. * Platelets: ↑↑ 2. Bone marrow: Hypercellular with predominance of granulopoiesis 3. Cytogenetics : Philadelphia chromosome 4. Serum uric acid is usually high. Chronic Myeloid Leukemia 9

10. 10 CML: peripheral blood film showing many mature neutrophils, some metamyelocytes, and a myelocyte.

11. 11 Thanks