| ID | 151 |
|---|---|
| Name | ACUTE LEUKEMIAS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. Blood- Hb% and R.B.C.- W.B.C.-usually 20,000-50,000/ c.m.m. Blast cells- 30%-90%. Normoblast may be present. Patelets- diminished. 2. Bone-marrow examination shows that it is usually hypercellular with replacement of the normal marrow elements by leukemic blast cells. The presence of Auer bodies in the cytoplasm of the blast cells indicates a myeloblastic type of leukemia. |
| Management | |
| Introduction | Acute leukemia is a malignancy of hemopoietic progenitor cells. The malignant cells lose there ability to mature and differentiate. These cells proliferate in an uncontrolled fashion and accumulation of useless cells in the marrow space, ultimately replace normal bone marrow elements.1 In acute leukemia, myeloid type is more common (about four times) in adult, but in children the lymphoblastic variety is more common |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Clinical features of all types of acute leukemias are almost similar. Onset may be sudden or insidious. The patient usually presents with nonspecific “Flu-like” symptoms or vague malaise and tiredness. There is fever, and a rapidly advancing anemia. Epistaxis, spongy bleeding gums or other hemorrhagic manifestations including purpura are common. Sore-throat and ulcers in the mouth and pharynx are frequent. There is hypertrophy of the gums. Muscle and joint pains may occur. The spleen and liver are enlarged in the latter stages. There may be cervical lymphadenopathy |
| Preventions | |
| Treatment | Treatment:2 Acute lymphoblastic leukemia: A. Supportive therapy: 1. If anemia- blood transfusion given. 2. If bleeding disorder- platelet transfusion. 3. If infection- antibiotics e.g gentamycin, cloxacillin etc. 4. If candidiasis of mouth-nystatin. 5. Regular bathing (antiseptic bath). 6. Psychological support. B. Specific therapy for ALL: Drugs commonly used 1. Remission induction: a. Vincristine i.v; b. L-asparaginase i.m; c. Daunorubicin i.v; d. Methotraxate (intrathecal); e. Tab. Prednisolone (oral). After full remission 2 more doses of vincristine and prednisolone should be given for 2 weeks. 2. Remission consolidation: a. Daunorubicin i.v; b. Cytarabine i.v; c. Etoposide i.v; d. Methotrexate i.v. An additional prophylactic course should be given for central nervous system as standard therapy does not penetrate CNS, such as- e. Cranio-axial radiation, f. Methotrexate (intrathecal) 3. Remission maintenance: a. Prednisolone (oral) b. Vincristine i.v; c. 6-Mercaptopurine (oral); d. Methotrexate (oral). Specific therapy for AML: Drugs commonly used 1. Remission induction: a. Daunorubicin i.v; b. Cytarabine i.v; c. Etoposide (i.v & oral) 2. Remission consolidation: a. Cytarabine i.v; b. Amsacrine i.v; c. Methotrexate i.v C. Bone-marrow transplantation. N.B: Dosage & duration of treatment- Please see in the text book. |
| Complications | |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team