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Acute Lymphoblastic Leukaemia (ALL)

N.B. Most common leukaemia in children


This is where there's uncontrolled proliferation of the lymphoid progenitor cell, which leads to lots of early lymphoid precursor cells replacing the normal haematopoietic cells of the bone marrow and infiltrating different organs. It leads to Pancytopenia (anaemia, leukopenia, thrombocytopenia).


N.B. Acute = Immature WBCs proliferating. Chronic = Mature WBCs proliferating.


Presentation

  • Failure to thrive

  • S+S of bone marrow failure

    • Anaemia – Fatigue, Pallor

    • Neutropenia – Recurrent infections

    • Thrombocytopenia – Petechiae, Abnormal bruising, Unexplained bleeding

  • S+S of organ infiltration

    • Bone pain

    • Lymphadenopathy

    • Hepatosplenomegaly


Investigations

  • FBC!

  • Blood film, which will show blast cells

  • Bone marrow and Lymph node biopsy


N.B. ALL is also associated with the Philadelphia chromosome (t(9;22) gene translocation), where it is a poor prognostic marker.

Cytology of a precursor (blast) cell, with features often seen even after partial differentiation into any of the more specific cell types. Wright's stain. © Mikael Häggström, MD CC0 1.0 (https://commons.wikimedia.org/wiki/File:Cytology_of_precursor_(blast)_cell.png) Blast cell from a case of acute promyelocytic leukemia. Wright's stain. © Mikael Häggström, MD CC0 1.0 (https://commons.wikimedia.org/wiki/File:Blast_cell_from_a_case_of_acute_promyelocytic_leukemia.jpg)

Management

  • Chemotherapy

  • Bone marrow transplant


There's around an 80% cure rate in those started on treatment!



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