Broadly speaking, blood cancer or leukemia can be divided into 2 types, as follows:
a. Acute leukemia
This type of leukemia is characterized by a very rapid, deadly and deteriorating course of the disease.
If not treated promptly, the penderitannya can die in a matter of weeks or days.
b. Chronic leukemia
It is a blood cancer that has a disease course that is not so fast that it has hope
Leukemia can also be classified according to the type of invaded white blood cell or lymphocytes myeloid. There are at least 4 common types of leukemia, as follows:
In chronic leukemia, the cells can mature partly but not completely. These cells may look fairly normal, but they are not. They generally do not fight infection as well as normal white blood cells do. The leukemia cells survive longer than normal cells, and build up, crowding out normal cells in the bone marrow. Chronic leukemias can take a long time before they cause problems, and most people can live for many years. But chronic leukemias are generally harder to cure than acute leukemias.
1. Chronic Lymphocytic Leukemia (CLL)
CLL most often occasionally in older people aged over 55 years. However, sometimes suffered by the patient
young adults. In contrast, there are hardly any cases in children.
Lymphocytic leukemias also known as lymphoid or lymphoblastic leukemia start in the cells that become lymphocytes. Lymphomas are also cancers that start in those cells. The main difference between lymphocytic leukemias and lymphomas is that in leukemia, the cancer cell is mainly in the bone marrow and blood, while in lymphoma it tends to be in lymph nodes and other tissues.
there are two type in CLL is
- One kind of CLL grows very slowly and so it may take a long time before the patient needs treatment.
- The other kind of CLL grows faster and is a more serious disease.
The leukemia cells from these 2 types look alike, but lab tests can tell the difference between them. The tests look for proteins called ZAP-70 and CD38. If the CLL cells contain low amounts of these proteins, the leukemia tends to grow more slowly.
2. Chronis Myleoid Leukemia (CML)
Is a type of leukemia that often occurs in adults and very little occurs in children. Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a myeloproliferative disorder characterized by increased proliferation of the granulocytic cell line without the loss of their capacity to differentiate. It accounts for 20% of all leukemias affecting adults. See the image below.
The clinical manifestations of CML are insidious, changing somewhat as the disease progresses through its 3 phases (chronic, accelerated, and blast). Signs and symptoms in the chronic phase are as follows:
- Fatigue, weight loss, loss of energy, decreased exercise tolerance
- Low-grade fever and excessive sweating from hypermetabolism
- Elevated white blood cell (WBC) count or splenomegaly on routine assessment
- Early satiety and decreased food intake from encroachment on stomach by enlarged spleen
- Left upper quadrant abdominal pain from spleen infarction
The following are signs and symptoms of progressive disease:
- Bleeding, petechiae, and ecchymoses during the acute phase
- Bone pain and fever in the blast phase
- Increasing anemia, thrombocytopenia, basophilia, and a rapidly enlarging spleen in blast crisis
The diagnosis of CML is based on the following:
- Histopathologic findings in the peripheral blood
- Philadelphia (Ph) chromosome in bone marrow cells
The workup for CML consists of the following:
- CBC with differential
- Peripheral blood smear
- Bone marrow analysis
Blood count and peripheral smear findings
- Total WBC count 20,000-60,000 cells/μL, with mildly increased basophils and eosinophils
- Mild to moderate anemia, usually normochromic and normocytic
- Platelet counts low, normal, or increased
- Leukocyte alkaline phosphatase stains very low to absent in most cells
- Leukoerythroblastosis, with circulating immature cells from the bone marrow
- Early myeloid cells (eg, myeloblasts, myelocytes, metamyelocytes, nucleated red blood cells)
Bone marrow findings
- Ph chromosome (a reciprocal translocation of chromosomal material between chromosomes 9 and 22)
- BCR/ABL mutation
- Hypercellularity, with expansion of the myeloid cell line (eg, neutrophils, eosinophils, basophils) and its progenitor cells
- Megakaryocytes are prominent and may be increased
- Mild fibrosis in the reticulin stain
for the acute type one is
3. Acute Lymphocytic leukemia (ALL)
Acute lymphoblastic leukemia (ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. ALL is the most common type of cancer and leukemia in children in the United States. The image below shows B-cell lymphoblastic leukemia/lymphoma (B-ALL).
4. Acute Myleoid Leukemia (AML)
is type of leukemia is more common in adults than children.
Acute myeloid leukemia (AML) is a malignant disease of the bone marrow in which hematopoietic precursors are arrested in an early stage of development. Most AML subtypes are distinguished from other related blood disorders by the presence of more than 20% blasts in the bone marrow.
The underlying pathophysiology in AML consists of a maturational arrest of bone marrow cells in the earliest stages of development. (See Pathophysiology.) Several factors have been implicated in the causation of AML, including antecedent hematologic disorders, familial syndromes, environmental exposures, and drug exposures. However, most patients who present with de novo AML have no identifiable risk factor.
Patients with AML present with symptoms resulting from bone marrow failure, symptoms resulting from organ infiltration with leukemic cells, or both. The time course is variable. (See Presentation.) The workup for AML includes blood tests, bone marrow aspiration and biopsy (the definitive diagnostic tests), and analysis of genetic abnormalities.