Hematology

Section-1 Red Blood Cells Unit-1 Normal morphology count, Isolation from whole blood & count Unit-2 Effect on count & morophology of physiochemical parameters & the diseased state Unit-3 Red cell anomalies & their relevance w.r.t normal & diseased state Unit-4 Blood Transfusion Unit-5 Pre-requisitement & the complication of mis-matched transfusion, Methods of blood matching Section-2 White blood cells & platelets Unit-6 Morphology count & methods of isolation Unit-7 Effect on count & morophology of cell by the physiochemical parameters,diseased Unit-8 State & the relevance of condition of the diseases Unit-9 Anaemias Defination(in general ) & courses Unit-10 Types of anaemia & their classification, Physiochemical Unit-11 Characteristic features & eterology of a plastic anaemia, haemoloytic,megaloblastic Unit-12 Clinical features & diagonosis Section-3 Leukaemia Unit-13 Definition (in general) & their etrology Unit-14 Classification of leukaemia, FAB classification, Etiologies ,physiochemical Unit-15 Features of different Type of leukaeias, with reference to clinical states Unit-16 Diagonosis of different types of leukaemias Section-4 Coagulation studies Unit-17 General pathways (intrinsic & extrinsic ) Unit-18 Properties ( physiochemical ) mode of action of coagulation factors Unit-19 Platelet studies ,platelet function tests ( for different Coagulation factors ) Unit-20 Effect of promoters & inhibitors at diff steps in coaguation,their solution & mode of action Unit-21 Diseases associated with coagulation disorders ,their etrology & characteristics Features Section-5 Red Cell mass studies Unit-22 Chemical method & radioactive methods Unit-23 Red Cell function studies Reference Books:1. Haematology at a Glance by Atul B.Mehta, Victor Hoffbrand 2. A beginner's guide to blood cells by Barbara J. Bain 3. Diagnostic Hematology by Norman Beck

Section-1 Red Blood Cells

Unit-1 Normal morphology count, Isolation from whole blood & count Unit-2 Effect on count & morphology of physiochemical parameters & the diseased state Unit-3 Red cell anomalies & their relevance w.r.t normal & diseased state Unit-4 Blood Transfusion Unit-5 Pre-requisitement & the complication of mis-matched transfusion, Methods of blood matching

Unit-1 Normal morphology count, Isolation from whole blood & count
1.1.1. 1.1.2. 1.1.3. 1.1.4. 1.1.5. 1.1.6. 1.1.7. 1.1.8. Objective Normal morphology count Isolation from Whole Blood & Count Summary Check Your Progress Glossary Reference Answer to Check Your Progress

1.1.1. Objective
This Unit studied about the Normal Sperm count basis on semen analysis, How to Improve Sperm Morphology, Boost Sperm Count, Isolation from whole blood & count.

1.1.2. Normal morphology count

Normal Sperm Count: Basics on Semen Analysis Regarding sperm morphology, the WHO criteria as described in 2010 state that a sample is normal (samples from men whose partners had a pregnancy in the last 12 months) if 4% (or 5th centile) or more of the observed sperm have normal morphology. Morphology is a predictor of success in fertilizing oocytes during in vitro fertilization. Up to 10% of all spermatozoa have observable defects and as such are disadvantaged in terms of fertilizing an oocyte Also, sperm cells with tail-tip swelling patterns generally have lower frequency of aneuploidy

A semen analysis requires collecting a semen sample from your partner. You should follow your doctor's instructions on how to collect the sample. Typically, semen collection will require masturbation and collection of the semen into a sterile container. It is often collected in a lab, but if it is collected at home it needs to be transported to the lab within an hour and kept free from extreme temperatures. Keeping it at body temperature is ideal. Normal Sperm Count - Normal Semen Analysis Results Normal Sperm Count Morphology Motility 20 to 150 million/ml 40% 20% What does sperm count mean? Sperm count refers to the amount of sperm per milliliter of semen collected. The amount of semen per ejaculation can vary quite a bit. Anywhere from less than a milliliter to 6 or 7 milliliters is considered normal. The test will then look at how many sperm are actually in the semen. As listed above, anywhere from 20 million per milliliter to 150 million is considered normal. What is morphology? Morphology is referring to the shape of the sperm. The sperm will be analyzed to see how many are shaped and formed properly. Normal results are about 40% or better shaped correctly. What is motility? Motility describes the movement of sperm. What will be looked at is how well the sperm move. What they want to see is if sperm are moving progressively forward, not in circles or sluggishly moving sperm. A normal result is at least 20% of the sperm showing progressive movement in a forward direction. What can I do if my partner's results are abnormal? As long as your partner is making some sperm, there is always the chance of getting pregnant. There are quite a few things that can affect sperm count. If you find that your partner's semen analysis is abnormal you will want to see a urologist. Causes of low sperm count - abnormal sperm count Medications: Certain medications such as Tagament, ketoconazole, and erythromycin. Talk to your doctor about any medications including over the counter and herbal medications or vitamins you are taking. Illness or infection: Low sperm count can be caused by something as simple as a virus or infection. If your partner has recently been ill, this could contribute to an abnormal sperm count.

Anatomical problems: There are certain conditions that can cause male factor fertility problems. One concern is a varicocele. A varicocele happens when the veins of the scrotum are swelled and dilated. It can be corrected with surgery. Other conditions such as retrograde ejaculations (ejaculating sperm back up into the bladder instead of ejaculating outward) and hormonal imbalances can also be a cause of male infertility. Blood tests can be used to check for hormonal imbalances and retrograde ejaculations may be able to be treated as simply as using a decongestant. It is important to discuss any and all medical treatments with your doctor. Vitamins and supplements to improve sperm count There are several supplements suggested for use in improving male fertility. Your doctor may suggest use of a daily multivitamin or some other vitamin regimen. Treatment options for low sperm count Along with options to improve sperm count, other options available include IUI (Intrauterine Insemination), IVF (In Vitro Fertilization), and male donor sperm. Improve Sperm Morphology Sperm morphology refers to the shape and structure of sperm. Normal sperm have an oval head and a straight tail that measures seven to 15 times the length of the head. Abnormal sperm have irregular shapes and forms. They might have unusually large or malformed heads, or tails that are short, coiled, or doubled. These defects prevent the sperm from either reaching or penetrating an egg. According to the World Health Organization, at least 60 percent of a man's sperm should have normal morphology. However, if a man has poor morphology, he might be able to improve the shape of his sperm by taking a few key steps. 1. Avoid heat. According to a 1998 study in the Journal of Human Reproduction, sperm anomalies can result if the scrotum is exposed to heat for prolonged periods of time. However, once exposure to the heat is eliminated or decreased, good sperm morphology increases. To ensure that your scrotum remains cool, avoid hot tubs and saunas, wear boxers (not briefs) and loose-fitting pants, and take care not to engage in long-distance bicycle riding or wear biker shorts for long periods. Eliminate environmental toxins. Mayoclinic.com reports that exposure to pollutants such as cigarette and marijuana smoke, pesticides, chemicals, and excessive amounts of alcohol can cause sperm to become misshapen. In addition, Dr. Randine Lewis of "How to Make a Family" notes that non-organic milk and meat can contain synthetic estrogen that can impair the healthy development of sperm. Men seeking to improve the quality of their sperm should adjust their lifestyle so that their exposure to these toxins is minimized or eliminated. Maintain a healthy diet. Certain vitamins and minerals, particularly selenium, can have a positive effect on sperm morphology. Selenium is an antioxidant-rich trace mineral that can

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be found in Brazil nuts, walnuts, tuna, beef, chicken, eggs, and cheese. It can also be taken in supplement form, although you should take no more than 400 mcg per day, as excessive amounts of selenium can be toxic. Other vitamins and minerals that can help improve the quality of sperm include vitamin C (which can be found in citrus fruits), zinc (found in lamb, beef, and oysters), folic acid (found in leafy green vegetables), vitamin E (from wheat germ, eggs, and sweet potatoes), and the amino acid L-arginine (from Brazil nuts, beef, chicken, chickpeas, and soy). Boost Sperm Count A sperm analysis can be performed for many reasons. It's especially critical when a couple is having difficulty in becoming pregnant. A sperm analysis assesses a sperm sample on three criteria: motility, morphology and count. Motility is how the sperm move, if they are fast or slow; morphology assesses the shape of the sperm. Sperm count is also an important criteria, as it may be difficult to achieve fertilization of an egg through intercourse if there aren't enough sperm. Boosting sperm count can be accomplished through lifestyle changes and dietary supplements. 1. 2. 3. Time your intercourse and ejaculation. Sperm count is highest when there's approximately 72 hours between ejaculations. Stop smoking. Cigarette smoking can decrease the count, motility, morphology and overall life span of sperm. This is true for tobacco and illegal products, such as marijuana. Maintain a healthy lifestyle with diet and exercise. Excess weight can cause hormone imbalances that affect sperm count. Fat tissue causes extra estrogen to be produced, which can decrease the number of viable sperm produced. Eat a healthy diet rich in vegetables and whole grains; avoid pesticides and toxins which may reduce sperm count by buying organic food. Take a multivitamin supplement. There are supplements designed to increase male fertility. These supplements have high levels of L-arginine, selenium and vitamin B12, which may help boost sperm count. Avoid excessive heat, particularly in the groin region. Don't soak in hot tubs or steam yourself in the sauna, avoid putting your laptop directly on your lap and make sure your underwear has a bit of, shall we say, breathing room.

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1.1.3. Isolation from Whole Blood & Count

DNA Extraction Protocol DNA extraction is the mechanical and/or biochemical isolation of DNA from cells in order to carry out downstream genetic experiments or DNA analyses. It is a primary step in molecular biology and forensic pathology and is a technique used by biological and medical scientists.

Hundreds of distinct DNA extraction protocols exist for different organisms, tissues, and biotechnological applications, and it may be essential to experiment to find the most optimal one. DNA Extraction Overview The process for obtaining DNA requires three separate experimental manipulations. First, the cells containing the DNA of interest must be broken open chemically or mechanically to release the DNA. Once the DNA is in a suspension, it is purified from contaminating cellular components such as lipids in the cell membrane, by washing with a detergent. The DNA is finally precipitated using cold alcohol and resuspended in an appropriate volume. Cell Collection and Lysis Tissues from which cells are going to be taken should be immediately placed on ice or frozen down to prevent DNA degradation from occurring. The most widely used DNA extraction protocol uses a chemical known as phenol-chloroform, which separates DNA from RNA and proteins. Tissues should first be cut into tiny portions to allow fast DNA extraction. If the tissue is rich in fibrous material or cell membranes, then protein digestion using protease or proteinase K will maximise the yield of DNA obtained at the end. A digestion buffer is prepared with TrisHydrochloric Acid, ethylenediaminetetraacetic acid, sodium chloride, sodium dodecyl sulfate, and maintained at pH 8. This buffer and proteinase K are added to the cells and incubated at 55 degrees Celsius for 12-16 hours (overnight), with some agitation. The sample is then centrifuged to form a pellet. Phenol-Chloroform Extraction Phenol-chloroform can be obtained in many formats for different applications, such as RNA or DNA extraction; therefore, it is important to use the correct one. For DNA extraction, a ratio of 25 parts phenol to 24 parts chloroform to 1 part isoamyl alcohol is required. Seven hundred microlitres of this solution is added to the pelleted cells and mixed for an hour on a tube inverter or tube rocker. The tube is centrifuged at no higher than 12,000 g, which separates the lysate into several distinct fractions. One of these is a clear upper phase containing the DNA and must be transferred into a fresh tube. DNA Precipitation The contents of the tube are pelleted in a centrifuge again, and the supernatant is discarded. The solid pellet must then be washed in cold ethanol (70 percent) to get rid of remaining salts from previous buffer washes, which can interfere with reactions utilizing the DNA, such as amplification (i.e., PCR). The sample is centrifuged to pellet the DNA and, again, the supernatant is discarded. The pellet can then be allowed to dry for no longer than 15 minutes, after which it is resuspended in the appropriate volume of Tris-EDTA and incubated for 10-15

minutes at 60-65 degrees Celsius. It is ready to use after the concentration and purity of the extracted DNA is ascertained by spectrophotometry. Optional Steps If it is important to prevent protein contamination in the final DNA sample; this can be done by including a protease digestion step prior to alcohol precipitation. In addition, where desired for downstream applications or other experiments, DNase treatment can be performed to prevent the enzyme DNaseI from degrading the DNA. How Does DNA Extraction Work DNA extraction is an important process that has played a part in just about every recent discovery involving genetics and disease. With DNA extraction, scientists can diagnose genetic disorders and diseases, discover new cells and viruses, and can even develop vaccines and cures for diseases that plague human, plant and animal life. The Cell DNA extraction starts with the cell or virus that needs to be studied. First, the cell is broken open. To do this, the cell is placed in a bead beating tube. Sodium acetate salt is applied to the cell to keep the proteins from degrading during the process. The detergent sodium dodecyl sulfate (SDS) is then applied to the cell to help remove the lipid membranes. It is then placed in phenol-chloroform for vortexing, to break down the proteinacious cellular walls. Seperation Once the cell has been broken open, it is placed in a centrifuge. Here the matter of the cell will separate into two parts. Between these two parts will be the DNA mixed with the sodium acetate; everything except for the DNA and salt mixture is extracted from the sample. Cold ethanol is then applied to the DNA, which dissolves the salt and isolates the extracted DNA.

1.1.4. Summary
Isolation Procedure and Freezing Procedure A commercial compound to promote separation is placed into each 50 mL centrifuge tube and the tubes are centrifuged for thirty seconds. Caps of blood tubes are sprayed with alcohol before opening, then anticoagulant-treated whole blood is then transferred via pipette into the centrifuge tubes. The plasma layer of the the blood is aspirated with a pipette. Freezing The cells from the previous step will then be centrifuged with buffered saline three times. After a cell count, the specimens will be centrifuged then suspended in freezing medium. Specimens in freezing medium are next divided between cryovials in one mL amounts. Vials are stored overnight in a -70C freezer and moved to long-term storage in liquid nitrogen the next day.

Safe Thawing Cryovials are transferred from liquid nitrogen to a 37C water bath and specimen is allowed to thaw one to two minutes. A warm transport media is added to each vial. Diluted cell suspension is centrifuged for seven minutes. The number and cell viability are checked, If cells need concentrating, specimens are centrifuged seven more minutes. The sample is diluted to working solution and rested for twelve to eighteen hours before beginning examination in the specified protocol.

1.1.5. Check Your Progress

1. What is morphology? 2. How Does DNA Extraction Work

1.1.6. Glossary
Red Cell Indices A standard complete blood count is performed on an automated laboratory instrument that quantities the amount of Hgb as well as the size, shape, and number of RBC's. A variety of calculations are performed to produce indices that provide information about RBC disorders. The standard indices are: RBC Count The number of RBC's per unit volume is measured directly and given in millions per microliter. Mean Corpuscular Volume (MCV) The MCV is measured directly; the unit is a femtoliter. The MCV measures the size of RBC's and is the most important index for classification of anemias into "macrocytic" with higher than normal MCV and "microcytic" with low MCV. Hemoglobin (Hgb) The Hgb content is measured directly and given in grams per deciliter. This value, along with Hct, provides the most useful measure of the oxygen carrying capacity of the blood. Hematocrit (Hct) = RBC count x MCV The Hct is a calculated value and provides a measure of the amount of oxygen carrying capacity of the blood. Mean Corpuscular Hemoglobin (MCH) = Hgb RBC count The MCH is calculated and gives the average mass of Hgb in an individual RBC; the unit is a picogram. Mean Corpuscular Hemoglobin Concentration (MCHC) = Hgb Hct The MCHC is calculated and provides a measure of the concentration of Hgb in the cells. Red Cell Distribution Width (RDW) = standard deviation of MCV The RDW is calculated to provide a measure of the anisocytosis, or variation in size of the RBC's.

1.1.8. Reference
Improve Sperm Morphology By Barbara Diggs Boost Sperm Count By Gwen Wark DNA Extraction Protocol By Palmer Owyoung DNA Extraction Work By Chris Sherwood

1.1.9. Answer to Check Your Progress

1. Read 1.1.2. 2. Read 1.1.3.

Unit-2 Effect on count & morphology of physiochemical parameters & the diseased state

Section-2 White blood cells & platelets

This Section Content Unit-6 Morphology count & methods of isolation Unit-7 Effect on count & morophology of cell by the physiochemical parameters, diseased Unit-8 State & the relevance of condition of the diseases Unit-9 Anaemias Defination(in general ) & courses Unit-10 Types of anaemia & their classification, Physiochemical Unit-11 Characteristic features & eterology of a plastic anaemia, haemoloytic,megaloblastic Unit-12 Clinical features & diagonosis

Unit-6 Morphology count & methods of isolation

2.6.1. 2.6.2. 2.6.3. 2.6.4. 2.6.5. 2.6.6. 2.6.7. 2.6.8. Objective Morphology & Increase Morphology Count Morphology methods of isolation Summary Check Your Progress Glossary Reference Answer to Check Your Progress

2.6.1. Objective
In this unit we studied about morphology & Increase Morphology count, Sperm Morphology, Ways to Improve Morphology of Sperm, Increase Morphology Sperm, Treatments for Sperm Morphology

2.6.2. Morphology & Increase Morphology Count

Morphology = shape of spermatozoa: Several techniques have been described to evaluate sperm morphology. Sperm are classified into normal-oval shaped, tapered, amorphous, duplicated and immature. Normal spermatozoid must have an oval form with smooth contour, acrosomal cap encompassing 40-70% of head, no abnormalities of midpiece, or tail and no cytoplasmic vacuoles of more than half of the sperm head. Head size is 5-6m M x 2.5-3.5m M. Any borderline sperm are counted as abnormal( amorphous, tapered,duplicated, immature, coiled tail, blunted tail, midpiece abnormalities). The predictive value of sperm morphology in determining pregnancy rates is low

a. WHO criteria: >30% normal forms ( 100 cells evaluated) b.Strict criteria (higher predictive value in determining rates of pregnancy in IVF program) are based on the morphology of postcoital spermatozoa found at the level of the internal cervical os. 100 cells evaluated for only normal sperm (>14% normal forms). Men with fewer than 4% normal forms usually failed to fertilize without micromanipulation. Strict criteria for normal sperm morphology include: Sperm head: Smooth oval configuration. Length-5-6 microns. Width:2.5-3.5 microns. Acrosome comprises 40-70% of the anterior sperm head Midpiece: Axially attached, 1.5 times the head length, 1m m in width Tail: Straight, uniform, slightly thinner than the midpiece, uncoiled, 45m m long Sperm Morphology An important part of any breeding soundness exam is an evaluation of sperm morphology. In the most fundamental case, the size and shape of the head, midpiece and tail are examined. Additional information can be gained by evaluating integrity of the acrosome and sperm membranes. Sperm from different species vary in size and shape. Bull and human sperm, for example, have paddle-shaped heads, rodent sperm have hook-shaped heads, and the heads of chicken sperm are spindle-shaped and almost difficult to distinguish from the midpiece. The images shown below of rat, bull and chicken sperm are all at the same magnification.

The results of a sperm morphology exam are reported as percent normal. It is always the case that some sperm from an ejaculate are morphologically abnormal, but when that fraction becomes excessive, fertility may decrease. It is also useful to subclassify the abnormal population into the types of abnormality observed. Two types of classification schemes are

commonly used:Abnormalities can be classified as affecting the head, midpiece or tail. The most basic type of classification scheme differentiates primary and secondary abnormalities:

Anatomic site of the defect: The problem can involve the head, midpiece or tail. Some abnormal sperm may have defects in more than one site. Primary versus secondary defects: Primary defects are the more severe and are thought to originate while the sperm was still within the semeniferous epithelium of the testis. Secondary defects are less serious and thought to arise during passage thought the epididymis or by mishandling after ejaculation. Some authors question the utility or physiologic basis of this pattern of classification.

Ways to Improve Morphology of Sperm Scientists now know that sperm morphology, or how the sperm is shaped, affects male fertility similarly to sperm count and motility (how the sperm moves). Patients with normal sperm morphology have improved chances at conceiving a baby, whether by intercourse, intrauterine insemination, or in-vitro fertilization. Even with poor sperm morphology, pregnancy may still be possible, but improving sperm morphology may result in improved male fertility. Sperm Morphology Normal sperm has an oval-shaped head that is 5 to 6 micrometers long and about 3 micrometers in diameter. A cap covers 40 to 70 percent of the head, and should be well defined. There should be no visible defect on the sperm, and no fluid droplets in the sperm head that are bigger than half the size of the sperm. Sperm are graded on their morphology according to a scale that measures the combination of these factors. If a male fertility test has come back with a sperm morphology lower than 4 percent on the sperm morphology scale, test again. The low sperm morphology could be temporary, and sometimes improves on its own. Other times, the low sperm morphology is a result of a testicular abnormality, injury or lifestyle choices, and will test the same on a subsequent test. Lifestyle Factors Quit smoking, cut back on alcohol consumption and exercise more. Do not use illicit drugs. Living a generally healthy lifestyle improves male fertility in general and improves the quality and number of sperm produced in the body. Cut back on fatty foods and increase the number of fruit and vegetable servings you eat each day. Tests conducted by Allan Pacey, senior lecturer in Andrology at the University of Sheffield, showed that men who ate fruits and vegetables high in antioxidants, along with cutting back on fatty foods and alcohol improved sperm counts and quality. Their diets included smoothies specially designed by a dietician to be high in antioxidants. Mix smoothies with blueberries, mango, raspberries, and oranges. Add honey for sweetness or mineral water for sparkle. Medical Options If your lifestyle is already generally healthy, and sperm morphology problems persist, see a specialist in the field. Doctors can treat low sperm morphology with prescription medication or

surgery. If a vacuole is found on the testicle, a doctor may perform surgery to remove it. In some cases, low sperm morphology persists despite treatment. If poor sperm morphology persists despite treatment, take heart. No evidence links birth defects in children conceived to poor sperm morphology. A couple can still conceive a healthy pregnancy despite low sperm morphology through intercourse in some cases, or with the help of infertility treatments such as IUI or IVF. How to Increase Morphology Sperm Sperm morphology is the term used to describe how a sperm is shaped, which can affect a males fertility. Normal sperm have an oval shaped head, and are around 3 micrometres big. There is a cap over around 60 percent of the sperm, and there should be no dents or visual deformities. Improving morphology greatly increases the chances of conception, and unlike sperm count or motility, its quite simple to improve morphology. Clean up your lifestyle. Smoking, drinking and taking drugs will all lower your general health, and this will affect sperm quality. Wear looser underwear. The American Society for Reproductive Medicine has linked tight underwear with lower sperm production levels, and a reduction is sperm quality. Increase the amount of antioxidants you consume. These are commonly found in fruits such as blueberries, mangos, raspberries and oranges. The University of Sheffield found that the inclusion of these combined with a healthier lifestyle improved sperm morphology.

What Are the Treatments for Sperm Morphology Sperm morphology refers to the size and shape of sperm; abnormal sperm is one possible cause of male infertility because sperm may have difficulty traveling to the egg or may be unable to fertilize it once there. There are a number of treatment options available depending on the cause of abnormal sperm. Cause Abnormal sperm morphology can occur when men are exposed to toxic chemicals such as drugs, cigarettes or household products; increased testicular temperature, often due to restrictive clothing or a varicose vein in the scrotum; or genetic inheritance. Lifestyle Treatments For some men, reversing abnormal sperm morphology is as simple as switching from briefs to boxers, avoiding drugs, cigarettes and common chemicals, and avoiding prolonged periods of sitting that cause the testicles to stay close to the body and heat up.

Professional Treatments A urologist can remove a varicose vein in the scrotum with surgery. However, many men with abnormal sperm morphology require fertility treatment in order to impregnate a partner; intracytoplasmic sperm injection (ICSI) and artificial insemination are two popular options, according to BabyCenter.com. Intracytoplasmic Sperm Injection Intracytoplasmic sperm injection (ICSI) is a process whereby sperm are directly injected into the egg outside of the womb, according to BabyCenter.com; the egg is then implanted into the uterus. Time Frame According to Oregon State University, it may take up to 18 months to see improved sperm morphology and only about half of all men see results.

2.6.3. Morphology methods of isolation

Morphological and physiological studies have not provided an understanding of the basic mechanisms of myocardial failure. It is possible that in some instances the myocardial cell itself is defective and that the defect may involve changes in the intra- cellular production, transport, or utilization of energy required for efficient contraction. One factor leading to such changes may be intrinsic to the myofibrils themselves, and our attention has been directed to the isolation and study of the activity of these intracellular contractile units. The syncytial nature of the myocardium renders the isolation of single, intact myofibrils more difficult than it is with skeletal muscle. The following method, however, has proved satis- factory. Methods to Isolate Bacteria Bacteria are essential for proper functioning of ecosystems. They decompose dead organisms and recycle organic material back into mineral nutrients. Isolating bacteria in a pure living culture helps researchers study and gain understanding about the physiological properties of certain organisms that is not possible to gather on a broader basis of study. Different bacteria prefer different physical and chemical conditions. Some have limited tolerances. For this reason, several methods are used to isolate and study microbes. Spread Plate The spread plate isolation method is a procedure where the researcher spreads a diluted cell mixture on an agar surface, using a sterile bent glass rod, in a way that every cell grows into its own separate colony. The cultures are incubated for a specific period of time. A macroscopically visible growth or cluster of microorganisms on the solid medium appears, each colony represents

a pure culture. After colonies are grown, they are counted and the number of bacteria in the original sample is calculated. Pour Plate Pour plate procedure is extensively used with bacteria and fungi and can also yield isolated colonies. A diluted bacterial specimen is prepared. The researcher introduces a small amount into an empty Petri dish. Melted agar is poured into the Petri dish containing the specimen. Agar and specimen are mixed thoroughly by covering the dish and gently tilting and swirling it. Agar is allowed time to gel while sitting on a flat surface. The covered dishes are inverted and incubated for a specific time period. Colonies are then observed and counted, and information is recorded. Streak Plate The streak plate method is the classic procedure for isolating individual strains of bacteria. The researcher sterilizes a wire loop in a flame. After cooling, the wire loop is touched to a sterile agar plate. The researcher dips the loop into the sample, picking up thousands of bacteria, then streaks the loop back and forth across the agar surface. After sterilizing the loop again and allowing it to cool, the researcher drags the loop through the previous path, picking up a batch of bacteria and streaks it onto the agar in a new area. This procedure is repeated several times. Closed dishes are incubated for a specific time period, after which the colony growth is observed. Exposure Plate Exposure of the sterile media to the environment demonstrates the aseptic technique. The researcher labels two nutrient agar plates for later comparison and observation and leaves them uncovered. One exposed agar plate is allowed to remain just as it is, exposing it to the environment for a short time period. The second plate is exposed to a source of possible contaminants, such as a sneeze, cough or fingers placed in physical contact with the agar surface. The plates are covered, inverted and incubated at room temperature for a period of time before observation.

2.6.4. Summary
Sperm counts are used to determine an underlying issue if a couple if unable to become pregnant. The production of sperm is complex. It relies on the normal functioning of the testes and the organs in your brain that stimulate hormones and sperm production, the pituitary glands and hypothalamus, respectively. Follow these steps to determine how to do a sperm count. The separation of cells that differ in size, shape (morphology), color or other physical characteristics requires good knowledge of the available technologies and the features of the cell mixture. For example, knowledge of proteins on the cell's surface can determine which technique is best for its isolation. This article will introduce several techniques that allow different cell types to be separated from one another. Bacteria can be identified by their shape and how they react to chemical tests. Among the most common tests are the Gram stain, slide agglutination and phage typing. However, due to

advancements in microbiology, scientists can further identify bacteria by DNA analysis.

2.6.5. Check Your Progress

1. What Are the Treatments for Sperm Morphology? 2. Explain the Methods to Isolate Bacteria

2.6.6. Glossary
Shape Bacteria come in three basic shapes: Cocci, bacilli and spirilla. Spirilla--like vibrios, spirilla and spirochetes--are shaped like spirals. They are some of the largest bacteria and the easiest to identify. Bacilli are rod-shaped. Depending on how they divide, they may be further classified into other groups. For instance, diplobacilli form groups of twos, streptobacilli form long chains and staphylobacilli form amorphous shapes. Cocci are circle-shaped. Like bacilli, they are also classified by the way they divide. Diplococci form groups of twos, streptococci form chains and staphylococci are amorphous. Some bacteria assume different shapes, even within the same petri dish. These are known as pleomorphic, as opposed to monomorphic, bacteria. Gram staining is a simple but highly useful process in identifying bacteria. First, a researcher will stain the bacteria with crystal violet and iodine. Next comes an alcohol rinse, then a counterstain with safranine, a reddish dye. Under a microscope, Gram-positive bacteria should appear deep purple or brown. Because of the peptidoglycan in their cell walls, they hold the crystal violet stain well, even after the alcohol rinse. Gram-negative bacteria, on the other hand, will appear pink or red. They contain relatively low amounts of peptidoglycan and thus have low affinity for crystal violet. Three-quarters of all known eubacteria (or "true bacteria") are Gram-negative. While the most common, the Gram stain is not the only stain test in use. Other stain tests can determine whether bacteria have endospores, capsules or flagella. DNA Analysis To identify bacteria through DNA analysis, researchers can measure the ratio of guanine-cytosine pairs. These pairs reveal how an unknown bacterium relates to those that are known. They can also reveal how bacteria are evolving. Another valuable means of identifying bacteria is nuclear hybridization. In nuclear hybridization, researchers heat a bacterium's complementary DNA strands, breaking the bonds between them. After a strand is isolated, researchers introduce DNA probes, which are short strands of another bacterium's DNA, and observe to what extent the strands combine, or hybridize. The greater the hybridization, the closer the relationship between the two bacteria. Spheres Spherical bacteria are called coccoid bacteria, and scientists give them more specific names depending on how they divide. For example, if coccoid bacteria stay attached in pairs, they are called diplococci. If they stay attached in groups of four, they are called tetrads. And if they stay attached in groups of eight (usually in cubic form), they are called sarcinae. Coccoid bacteria can also form other shapes. Streptococci forms chains,

and staphylococci have no regular shape at all. Certain types of staphylococci are common on human skin. Rods Rods come in many different types. Some rods, for instance, are curved, and others are shaped like cigars, ovals, or staffs. Like coccoid bacteria, they can be further classified based on how they divide. Diplobacilli stay attached end-to-end, forming pairs; streptobacillia form chains; and coccobacillia have no distinct shape. One important type of rod-shape bacteria is called a nitrogen-fixing bacteria. Through chemical processes, these bacteria change nitrogen gas into the ammonium found in the earth's soil. Spirals Spiral-shaped bacteria come in three different forms: vibrio, spirillum, or spirochete. A vibrio looks like a comma; take for example, the Bifidobacterium spp., which occurs naturally in the large intestine. A spirillum, on the other hand, is a thick, stiff spiral. The spirochete is thin and supple. Other Shapes With the billions of different bacteria on and in the earth, other shapes also exist. To name just a few, bacteria may be lobed, star-shaped, square-shaped, spindle-shaped, or filamentous. Filamentous bacteria, for example, are used in sewer and waste water management systems. Pleomorphic Bacteria Bacteria that retain their shape are called monomorphic; thos that do not are called polymorphic. Polymorphic bacteria, like the Mycoplasma pneumoniae, can assume a number of different shapes, even within the same culture. As its name suggests, Mycoplasma pneumoniae causes walking pneumonia, and it is so small that it resembles a large virus in size. Other types of polymorphic bacteria include Rickettsia rickettsii, which causes Rocky Mountain spotted fever, and Bacillus anthracis, which causes anthrax.

2.6.7. Reference
Methods to Isolate Bacteria By Karen Curinga Tests Used in the Identification of Bacteria by David Chandler

2.6.8. Answer to Check Your Progress

1. Read 2.6.2. 2.Read 2.6.3

Section-3 Leukemia
Unit-13 Definition (in general) & their etrology Unit-14 Classification of leukaemia, FAB classification, Etiologies ,physiochemical Unit-15 Features of different Type of leukaeias, with reference to clinical states Unit-16 Diagonosis of different types of leukaemias

Unit-13 Definition (in general) & their etiology

3.13.1. Objective 3.13.2. What is Leukemia 3.13.3. Functions of bone marrow & Causes of leukemia. 3.13.4. Types of Leukemia & Lymphocytic and Myelogenous 3.13.5. Symptoms of Leukemia & Treatment for Leukemia 3.13.6. Etiology of Leukemia 3.13.7. Summary 3.13.8. Check Your Progress 3.13.9. Glossary 3.13.10. Reference 3.13.11. Answer to Check Your Progress

3.13.1. Objective
In this Unit we are going to studied about What is leukemia, What causes Leukemia, the Function of the bone marrow, Causes of leukemia,Types of Leukemia, Lymphocytic and Myelogenous, Symptoms of Leukemia, , treatment for Leukemia, etiology of Leukemia.

3.13.2. What is Leukemia & Causes?

The word Leukemia comes from the Greekleukos which means "white" and aima which means "blood". It is cancer of the blood or bone marrow (which produces blood cells). A person who has leukemia suffers from an abnormal production of blood cells, generally leukocytes (white blood cells). The DNA of immature blood cells, mainly white cells, becomes damaged in some way. This abnormality causes the blood cells to grow and divide chaotically. Normal blood cells die after a while and are replaced by new cells which are produced in the bone marrow. The abnormal blood cells do not die so easily, and accumulate, occupying more and more space. As more and more space is occupied by these faulty blood cells there is less and less space for the normal cells

- and the sufferer becomes ill. Quite simply, the bad cells crowd out the good cells in the blood. In order to better understand what goes on we need to have a look at what the bone marrow does.

3.13.3. Functions of bone marrow & Causes of leukemia.

The bone marrow is found in the inside of bones. The marrow in the large bones of adults produces blood cells. Approximately 4% of our total bodyweight consists of bone marrow. There are two types of bone marrow: 1. Red marrow, made up mainly of myeloid tissue. 2. Yellow marrow, made up mostly of fat cells. Red marrow can be found in the flat bones, such as the breast bone, skull, vertebrae, shoulder blades, hip bone and ribs. Red marrow can also be found at the ends of long bones, such as the humerus and femur. White blood cells (lymphocytes), red blood cells and platelets are produced in the red marrow. Red blood cells carry oxygen, white blood cells fight diseases. Platelets are essential for blood clotting. Yellow marrow can be found in the inside of the middle section of long bones. If a person loses a lot of blood the body can convert yellow marrow to red marrow in order to raise blood cell production. White blood cells, red blood cells and platelets exist in plasma - Blood plasma is the liquid component of blood, in which the blood cells are suspended. Causes leukemia Experts say that different leukemias have different causes. The following are either known causes, or strongly suspected causes:

Artificial ionizing radiation Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus) Benzene and some petrochemicals Alkylating chemotherapy agents used in previous cancers Maternal fetal transmission (rare) Hair dyes Genetic predisposition - some studies researching family history and looking at twins have indicated that some people have a higher risk of developing leukemia because of a single gene or multiple genes. Down syndrome - people with Down syndrome have a significantly higher risk of developing leukemia, compared to people who do not have Down syndrome. Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk. Electromagnetic energy - studies indicate there is not enough evidence to show that ELF magnetic (not electric) fields that exist currently might cause leukemia. The IARC

(International Agency for Research on Cancer) says that studies which indicate there is a risk tend to be biased and unreliable.

3.13.4. Types of Leukemia & Lymphocytic and Myelogenous

Chronic and Acute Experts divide leukemia into four large groups, each of which can be Acute, which is a rapidly progressing disease that results in the accumulation of immature, useless cells in the marrow and blood, or Chronic, which progresses more slowly and allows more mature, useful cells to be made. In other words, acute leukemia crowds out the good cells more quickly than chronicleukemia. Lymphocytic and Myelogenous Leukemias are also subdivided into the type of affected blood cell. If the cancerous transformation occurs in the type of marrow that makes lymphocytes, the disease is calledlymphocytic leukemia. A lymphocyte is a kind of white blood cell inside your vertebrae immune system. If the cancerous change occurs in the type of marrow cells that go on to produce red blood cells, other types of white cells, and platelets, the disease is called myelogenous leukemia. To recap, there are two groups of two groups - four main types of leukemia, as you can see in the illustration below:

Acute Lymphocytic Leukemia (ALL), also known as Acute Lymphoblastic Leukemia - This is the most common type of leukemia among young children, although adults can get it as well, especially those over the age of 65. Survival rates of at least five years range from 85% among children and 50% among adults. The following are all subtypes of this leukemia: precursor Bacute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia. Chronic Lymphocytic Leukemia (CLL) - This is most common among adults over 55, although younger adults can get it as well. CLL hardly ever affects children. The majority of patients with CLL are men, over 60%. 75% of treated CLL patients survive for over five years. Experts say CLL is incurable. A more aggressive form of CLL is B-cell prolymphocytic leukemia.

Acute Myelogenous Leukemia (AML) - AML is more common among adults than children, and affects males significantly more often than females. Patients are treated with chemotherapy. 40% of treated patients survive for over 5 years. The following are subtypes of AMS - acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia. Chronic Myelogenous Leukemia (CML) - The vast majority of patients are adults. 90% of treated patients survive for over 5 years. Gleevec (imatinib) is commonly used to treat CML, as well as some other drugs. Chronic monocytic leukemia is a subtype of CML.

3.13.5. Symptoms of Leukemia & Treatment for Leukemia

Symptoms of leukemia Blood clotting is poor - As immature white blood cells crowd out blood platelets, which are crucial for blood clotting, the patient may bruise or bleed easily and heal slowly - he may also develop petechiae (a small red to purple spot on the body, caused by a minor hemorrhage). Affected immune system - The patient's white blood cells, which are crucial for fighting off infection, may be suppressed or not working properly. The patient may experience frequent infections, or his immune system may attack other good body cells. Anemia - As the shortage of good red blood cells grows the patient may suffer from anemia - this may lead to difficult or labored respiration (dyspnea) and pallor (skin has a pale color caused by illness). Other symptoms - Patients may also experience nausea, fever, chills, night sweats, flulike symptoms, and tiredness. If the liver or spleen becomes enlarged the patient may feel full and will eat less, resulting in weight loss. Headache is more common among patients whose cancerous cells have invaded the CNS (central nervous system). Precaution - As all these symptoms could be due to other illnesses. A diagnosis of leukemia can only be confirmed after medical tests are carried out.

Treatments for leukemia As the various types of leukemias affect patients differently, their treatments depend on what type of leukemia they have. The type of treatment will also depend on the patient's age and his state of health. In order to get the most effective treatment the patient should get treatment at a center where doctors have experience and are well trained in treating leukemia patients. As treatment has improved, the aim of virtually all health care professionals should be complete remission - that the cancer goes away completely for a minimum of five years after treatment. Treatment for patients with acute leukemias should start as soon as possible - this usually

involves

induction

therapy

with

chemotherapy,

and

takes

place

in

hospital.

When a patient is in remission he will still need consolidation therapy or post induction therapy. This may involve chemotherapy, as well as a bone marrow transplant (allogeneic cell transplantation). If a patient has Chronic Myelogenous Leukemia (CML) his treatment should start as soon as the diagnosis is confirmed. He will be given a drug, probably Gleevec (imatinib mesylate), which blocks the BCR-ABL cancer gene. Gleevec stops the CML from getting worse, but does not cure it. There are other drugs, such as Sprycel (dasatinib) and Tarigna (nilotinb), which also block the BCR-ABL cancer gene. Patients who have not had success with Gleevec are usually given Sprycel and Tarigna. All three drugs are taken orally. A bone marrow transplant is the only current way of curing a patient with CML. The younger the patient is the more likely the transplant will be successful. Patients with Chronic Lymphocytic Leukemia (CLL) may not receive any treatment for a long time after diagnosis. Those who do will normally be given chemotherapy or monoclonal antibody therapy. Some patients with CLL may benefit from allogeneic stem cell transplantation (bone marrow transplant). All leukemia patients, regardless of what type they have or had, will need to be checked regularly by their doctors after the cancer has gone (in remission). They will undergo exams and blood tests. The doctors will occasionally test their bone marrow. As time passes and the patient continues to remain free of leukemia the doctor may decide to lengthen the intervals between tests.

3.13.6. Etiology of Leukemia

Leukemia was going through a lot of research work, but not yet fully understood causes of leukemia. Currently considered the following factors: Viral factors: the early 50's discovered a murine leukemia virus infection in newborn rats after neonatal mice can lead to leukemia. Therefore, it has been suspected of human leukemia may also be caused by a virus, but has long been no definite conclusions. Until recently, in the etiology of human leukemia virus, able to achieve a major breakthrough. RNA tumor virus in mice, cats, chickens and cattle and other animals, had already recognized the role of induced leukemia, this virus is mostly due to T-cell leukemia. In recent years, from adult T-cell leukemia and lymphoma in patients with isolated human T-cell leukemia virus (HTLV), which is a C-type retrovirus. In the Japanese T-cell leukemia patients were also found in the serum anti-HTLV-structural protein antibodies. However, such a virus has not yet found a clear relationship between the children with leukemia. Chemical factors: some chemical substances caused leukemia effect. Regular contact with benzene and its derivatives, the crowd of leukemia is higher than the general population incidence. Such as diphenyl anthracene, pyrene and other benzene-induced leukemia in mice in the. Nitrosamine substance Phenylbutazone and its derivatives, such as

chloramphenicol-induced leukemia, the report also can be seen, but the lack of statistical information. Some of the anti-tumor cytotoxic drugs, such as nitrogen mustard, cyclophosphamide, methyl benzyl hydrazine, VP16, VM26 and so there is an acknowledged role of leukemia induced by chemical substances caused leukemia, mostly acute Feilin white hyperlipidemia. Prior to the emergence of leukemia, often present an early stage of leukemia, usually manifested pancytopenia. Ionizing radiation: there is clear evidence that certain conditions can cause a variety of ionizing radiation of human leukemia. The occurrence of leukemia depends on the absorbed radiation dose, the whole body or part of the body by the medium-dose or high-dose radiation can induce leukemia. However, small doses of radiation can cause leukemia, is still uncertain. Japanese cities of Hiroshima and Nagasaki after the atomic bomb explosion, serious radiation areas in the incidence of leukemia was unaffected radiation area 17 ~ 30 times. 3 years after the explosion, the incidence of leukemia increased year by year, 5 to 7 years reached its peak. To 20 years later, its incidence rate is restored to a level close to the Japanese. This is the radiation can cause the most direct evidence of human leukemia. Radiation workers, frequent contact with radioactive material and the incidence of leukemia has also several times higher than normal, often accept the diagnosis and treatment of radiation can lead to increased incidence of leukemia, which also proved that radiation does cause leukemia effect. Genetic factors: In recent years studies have proven that the number of chromosomes increase or decrease the number of such abnormalities, as well as translocation, inversion, deletion and other structural abnormalities, so that gene structure, expression abnormalities. Gene expression or gene inactivation of one of the foundations of cell malignant transformation. There chromosomal aberrations of people is higher than normal incidence of leukemia. Such as the 21 - Children with trisomy 10-year-old leukemia incidence rate of less than 1 / 74, Bloom syndrome, the incidence rate of less than 26-year-old 1 / 3, Fanconi (congenital aplastic anemia) syndrome 21-year-old the incidence rate of less than 1 / 12. Some statistical analysis of the same family, several cases of leukemia occurred in the patient's condition that there are genetic factors which may exist, when the family has a member of leukemia, his next of kin leukemia chance than most people 4 times higher. In some congenital diseases such as type of congenital stupidity, also more prone to leukemia. Twins in the same eggs in one leukemia, the other party the opportunity leukemia as high as 25%. These examples illustrate the pathogenesis of leukemia, there exists the possibility of genetic factors. Other blood disorders: Some blood diseases may be found that acute leukemia, such as chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, bone marrow fibrosis, myelodysplastic syndrome, paroxysmal nocturnal hemoglobinuria urine, lymphoma, multiple myeloma. Overall, the incidence of leukemia is a complex result of the role of multiple factors, genetic predisposition, viruses, radiation, chemical substances may interact, with overlapping roles in the occurrence of leukemia.

3.13.7. Summary
Acute lymphocytic leukemia Acute lymphocytic leukemia (ALL) is a type of cancer of the blood and bone marrow the spongy tissue inside bones where blood cells are made. The word "acute" in acute lymphocytic leukemia comes from the fact that the disease progresses rapidly and affects immature blood cells, rather than mature ones. The "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes, which ALL affects. Acute lymphocytic leukemia is also known as acute lymphoblastic leukemia and acute childhood leukemia. Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance for a cure. Acute lymphocytic leukemia can also occur in adults, though the prognosis is not as optimistic. Chronic lymphocytic leukemia Chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) is a monoclonal disorder characterized by a progressive accumulation of functionally incompetent lymphocytes. It is the most common form of leukemia found in adults in Western countries Onset is insidious, and it is not unusual for CLL to be discovered incidentally after a blood cell count is performed for another reason. Enlarged lymph nodes are the most common presenting symptom, but patients may present with a wide range of symptoms and signs. (See Clinical.) Chemotherapy is not needed in CLL until patients become symptomatic or display evidence of rapid progression of disease. A variety of chemotherapy regimens are used in CLL. These may include nucleoside analogues, alkylating agents, and biologics, often in combination. Allogeneic stem cell transplantation is the only known curative therapy Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, is a cancer of the myeloid line of blood cells, characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells. AML is the most common acute leukemia affecting adults, and its incidence increases with age Chronic myelocytic leukemia Chronic myelocytic (myeloid, myelogenous, granulocytic) leukemia is a disease in which cells that normally would develop into neutrophils, basophils, eosinophils, and monocytes become cancerous. People pass through a phase in which they have nonspecific symptoms such as tiredness, anorexia, and weight loss. As the disease progresses, the lymph nodes and spleen enlarge, and people may also be pale and bruise or bleed easily.

Blood tests, bone marrow examination, and chromosome analysis are needed for diagnosis. Treatment is with imatinib or with high doses of chemotherapy drugs followed by stem cell transplantation. Chronic myelocytic leukemia (CML) may affect people of any age and of either sex but is uncommon in children younger than 10 years. The disease most commonly develops in adults between the ages of 40 and 60. The cause usually is a rearrangement of two particular chromosomes into what is called the Philadelphia chromosome. The Philadelphia chromosome produces an abnormal enzyme (tyrosine kinase), which is responsible for the abnormal growth pattern of the white blood cells in CML. In CML, most of the leukemia cells are produced in the bone marrow, but some are produced in the spleen and liver. In contrast to the acute leukemias, in which large numbers of immature white blood cells (blasts) are present, the chronic stage of CML is characterized by marked increases in the numbers of normal-appearing white blood cells and sometimes platelets. During the course of the disease, more and more leukemia cells fill the bone marrow and others enter the bloodstream. Eventually the leukemia cells undergo more changes, and the disease progresses to an accelerated phase and then inevitably to blast crisis. In blast crisis, only immature leukemia cells are produced, a sign that the disease has become much worse. Massive enlargement of the spleen is common in blast crisis, as well as fever and weight loss.

3.13.8. Check Your Progress

1. What are the Causes for leukemia? 2. What are the Treatments for leukemia

3.13.9. Glossary
Abdomen: The belly, that part of the body that contains all of the structures between the chest and the pelvis. The abdomen is separated anatomically from the chest by the diaphragm, the powerful muscle spanning the body cavity below the lungs. Abnormal: Not normal. Deviating from the usual structure, position, condition, or behavior. In referring to a growth, abnormal may mean that it is cancerous or premalignant (likely to become cancer). Acute myeloid leukemia: A quickly progressive malignant disease in which there are too many immature blood-forming cells in the blood and bone marrow, the cells being specifically those destined to give rise to the granulocytes or monocytes, both types of white blood cells that fight infections. In AML, these blasts do not mature and so become too numerous. AML can occur in

adults or children. Acute myeloid leukemia is abbreviated AML (pronounced A M L). It is also known as acute myelogenous leukemia or acute nonlymphocytic leukemia (ANLL). Allogeneic: Taken from different individuals of the same species. Two or more individuals are said to be allogeneic to one another when the genes at one or more loci are not identical. Anemia: The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased. Bone marrow: The soft blood-forming tissue that fills the cavities of bones and contains fat and immature and mature blood cells, including white blood cells, red blood cells, and platelets. Diseases or drugs that affect the bone marrow can affect the total counts of these cells. Lungs: The lungs are a pair of breathing organs located with the chest which remove carbon dioxide from and bring oxygen to the blood. There is a right and left lung. Lymph: An almost colorless fluid that travels through vessels called lymphatics in the lymphatic system and carries cells that help fight infection and disease. Lymphocytic: Referring to lymphocytes, a type of white blood cell. Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop.

3.13.10.

Reference
Chronic Myelocytic Leukemia By Emil J. Freireich MD Leukemia and Lymphoma Society, Cancer Research UK

3.13.11.

Answer to Check Your Progress

1. Read 3.13.3. 2. Read 3.13.5.

SECTION 3 Unit-14 Classification of leukemia, FAB classification, Etiologies, physiochemical

3.14.1. Objective 3.14.2. Classification of Leukemia 3.14.3. FAB Classification 3.14.4. Etiologies, Physiochemical 3.14.5. Summary 3.14.6. Check Your Progress 3.14.7. Glossary 3.14.8. Reference 3.14.9. Answer to Check Your Progress

3.14.1. Objective
In this unit we studied about the Leukemia classifications, French American British Classifications, Etiologies and Physiochemical.

3.14.2. Classification of Leukemia

Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its acute and chronic forms: Acute leukemia is characterized by a rapid increase in the numbers of immature blood cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children. Chronic leukemia is characterized by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal cells, resulting in many abnormal white blood cells in the blood. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group. Additionally, the diseases are subdivided according to which kind of blood cell is affected. This split divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias:

In lymphoblastic or lymphocytic leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes, which are infection-fighting immune system cells. Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B cell. In myeloid or myelogenous leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets. Combining these two classifications provides a total of four main categories. Within each of these four main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme. Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in young children. This disease also affects adults, especially those age 65 and older. Standard treatments involve chemotherapy and radiotherapy. The survival rates vary by age: 85% in children and 50% in adults. Subtypes include precursor B acute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia. Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%. It is incurable, but there are many effective treatments. One subtype is B-cell prolymphocytic leukemia, a more aggressive disease. Acute myelogenous leukemia (AML) occurs more commonly in adults than in children, and more commonly in men than women. AML is treated with chemotherapy. The five-year survival rate is 40%. Subtypes of AML include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia. Chronic myelogenous leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease. Treatment is with imatinib (Gleevec in US, Glivec in Europe) or other drugs. The five-year survival rate is 90%. One subtype is chronic monocytic leukemia. Hairy cell leukemia (HCL) is sometimes considered a subset of CLL, but does not fit neatly into this pattern. About 80% of affected people are adult men. There are no reported cases in young children. HCL is incurable, but easily treatable. Survival is 96% to 100% at ten years. T-cell prolymphocytic leukemia (T-PLL) is a very rare and aggressive leukemia affecting adults; somewhat more men than women are diagnosed with this disease. Despite its overall rarity, it is also the most common type of mature T cell leukemia; nearly all other leukemias involve B cells. It is difficult to treat, and the median survival is measured in months. Large granular lymphocytic leukemia may involve either T-cells or NK cells; like hairy cell leukemia, which involves solely B cells, it is a rare and indolent (not aggressive) leukemia. Adult T-cell leukemia is caused by human T-lymphotropic virus (HTLV), a virus similar to HIV. Like HIV, HTLV infects CD4+ T-cells and replicates within them; however, unlike HIV, it does not destroy them. Instead, HTLV "immortalizes" the infected T-cells, giving them the ability to proliferate abnormally.

3.14.3. FAB classification

French-American-British classification of acute leukemia Hematology A schema that divides acute leukemias into lymphoidALL or myeloidAML cell lines; of childhood ALL, 70% are predominantly L1, 27% are L2, and 3% or less are L3 or Burkitt cell type, in adults with ALL, 30% are L1, 65% are L2, and 5% are L3 FAB classification, acute leukemias Acute lymphocytic leukemia (ALL) L1 Small monotonous lymphocytes L2 Mixed L1- and L3-type lymphocytes L3 Large homogeneous blast cells Acute myeloid leukemia (AML) M1 Myeloblasts without maturation M2 Myeloblasts with maturation (best AML prognosis) M3 Hypergranular promyelocytic leukemia (faggot cells) M3V Variant, microgranular promyelocytic leukemia M4 Myelomonocytic leukocytes M5 Monocytic, subtype a. Poorly differentiated monocytic leukemia b. Well differentiated monocytic leukemia M6 Erythroleukemia/DiGuglielmo syndrome M7 Megakaryocytic leukemia Pleomorphic undifferentiated cells with cytoplasmic blebs; myelofibrosis or BM reticulin; positive for platelet peroxidase antifactor VIII The French-American-British (FAB) classification of AML In the 1970s, a group of French, American, and British leukemia experts divided acute myeloid leukemias into subtypes, M0 through M7, based on the type of cell from which the leukemia developed and how mature the cells are. This was based largely on how the leukemia cells looked under the microscope after routine staining. FAB subtype Name M0 M1 M2 M3 M4 Undifferentiated leukemia acute myeloblastic 5% leukemia leukemia with 15% with 25% 10% 20% 5% Better Best Average Better Average Worse % of adult Prognosis compared to AML patients average for AML

Acute myeloblastic minimal maturation Acute myeloblastic maturation

Acute promyelocytic leukemia (APL) Acute myelomonocytic leukemia

Acute myelomonocytic leukemia with M4 eos eosinophilia

M5 M6 M7

Acute monocytic leukemia Acute erythroid leukemia Acute megakaryoblastic leukemia

10% 5% 5%

Average Worse Worse

Subtypes M0 through M5 all start in precursors of white blood cells. M6 AML starts in very early forms of red blood cells, while M7 AML starts in early forms of cells that make platelets. Some subtypes of AML defined in the FAB system are linked with certain symptoms. For example, bleeding or blood clotting problems are often a problem for patients with the M3 subtype of AML, also known as acute promyelocytic leukemia (APL). Identifying APL is very important for 2 reasons. First, certain complications of APL can often be prevented by appropriate treatment. Second, APL is treated differently from most other forms of AML -- it usually responds to retinoids (drugs related to vitamin A).

3.14.4. Etiologies, Physiochemical

A variety of factors probably are etiologically involved in leukemia, not only in different cases but also within individual cases. Abnormalities of chromosomes have been found in various types of leukemia. Whether these chromosomal alterations are primary or secondary is undetermined, but it is likely that they are at least contributory in the development of leukemia. There is an increasing body of evidence incriminating viruses in leukemogenesis in man, and they may be a factor in all cases. Certain chemicals may be important etiologic factors in a few cases. Many different studies have established that ionizing radiation in large doses may be leukemogenic. Whether small doses of irradiation are dangerous has not been demonstrated. Nucleic Acids and Chromosomes It is now recognized that deoxyribonucleic acid (DNA) in chromosomes performs two important control functions. First it controls cell division because of the necessity for it to replicate itself for mitosis to occur, and second it determines nucleotide sequence in ribonucleic acid which in tum determines amino acid sequence in proteins. Therefore, in uncontrolled proliferation of cells as seen in leukemia these functions of DNA would be expected to be faulty. If so, the chromosomes might be morphologically abnormal, although not necessarily so. Since 1960, a number of chromosomal abnormalities have been found in the various types of leukemia. Nowell and Hungerford41 in 1960 first reported an abnormality of chromosome 21 in chronic granulocytic leukemia (CGL). This abnormal chromosome, called Philadelphia chromosome or Ph,' is characterized by the absence of a part of one of its long arms. When bone marrow is examined directly, the majority of dividing cells in most cases of CGL have been Ph' positive irrespective of the stage of the disease and of therapy. The significance of these chromosomal abnormalities in leukemia remains to be determined, but it seems likely that they are either primary and causal or at least secondary but contributory.

Viruses In 1951 Gross reported that leukemia developed in a strain of mice in which spontaneous leukemia does not occur (c3H strain) after the injection of cell-free extracts of leukemic tissue from a strain of mice in which leukemia had developed spontaneously (AK STRAIN). He also was able to produce leukemia in the C3H mouse by injecting an extract made from embryos of non-leukemic AK mice. Feldman and Gross subsequently demonstrated by electron microscopy the presence of virus-like particles in several organs of c3H mice with this induced leukemia. In spite of unsuccessful attempts to transmit leukemia from man to man, in the last few years an increasing body of evidence has accumulated suggesting an etiological relationship between viruses and human leukemia. Almeida and coworkers consistently found virus-like particles in the blood of two patients with acute granulocytic leukemia. Dmochowski18 has reported the presence of virus particles in the lymph nodes of the majority of patients with various types of leukemia and lymphoma. These particles morphologically were similar to those found in mouse, rat and chicken leukemia. Whitaker and coworkers54 were able to produce cellular alterations in ceils in tissue culture when they were inoculated with cell-free extracts of human leukemic brain; whereas extracts from normal human brain did not produce similar changes. In 1964 Negroni reported that a cytopathic virus was cultured from the bone marrow of 40 per cent of patients who had leukemia. Antisera to these viruses neutralized 100 tissue culture doses of the homologous strain. Negroni also found that in seven of eight patients with leukemia a 1:10 dilution of their serum neutralized between 10 and 100 tissue culture doses of this virus. Herpes simplex antisera did not kill these viruses. More recently Murphy, Furtado and Plata39 isolated cytopathic agents from the bone marrow of 45 per cent of children with acute leukemia. Viruslike particles were seen on electron microscopy of the infected tissue culture cells; and the agents isolated, when injected into mice, produced a leukemia-like picture. There have been several reports of clustering of cases of leukemia. In Niles, Ill., where eight cases of acute leukemia occurred in children in a three-year period,29'30 all but one of these children either attended or had a sibling attending the same school. Other instances of clustering of leukemia have been reported.43849 Evidence against the occurrence of clusters by mere chance has been reported by Ederer.19 Schwartz and cowork- ers examined specimens of serum from the other members of the families of the patients with leukemia in the Niles cluster. Using brain tissue from patients with leukemia as an antigen, they were able to demonstrate an antibody in over 40 per cent of the specimens. They also found positive reactions in specimens of serum taken from 12 of their laboratory personnel working with experimental leukemia-including four who had negative reaction when they first began this work. These studies of leukemia clusters suggest that a specific leukemogen was operative in these cases, and the studies of Schwartz suggest that a virus may have been the leukemogenic agent.

Chemicals
Of all the chemicals to which people in our society are exposed only benzene is widely accepted as a definite leukemogen.16 However, other chemicals have been implicated-for example, an insecticide, and hexachlorcyclohexane. Various hematologic disorders of obscure cause (such as aplastic anemia) may be followed by acute leukemia.4'17 Therefore, any chemical or drug which may cause aplastic anemia, for

example, should be held suspect as a possible leukemogenic agent. There is a good deal of circumstantial evidence to implicate phenylbutazone in this regard. In 1960 Bean3 reported three or four cases of acute leukemia in elderly persons who had been receiving this drug. Subsequently, single cases of acute leukemia following the administration of phenylbutazone were reported by at least six observers.7-10'28'51 In 1964 Woodliff and Dougan55 reported five cases in which there was this association. They estimated that in western Australia, during the period of their study, in 9 per cent of the cases of acute leukemia phenylbutazone had been given previously. If there is an increased incidence of leukemia among those receiving phenylbutazone, those most likely to be affected are elderly patients who have taken the drug for long periods and who have had bone marrow depression.

3.14.5. Summary
Leukemia Causes The exact cause of leukemia is unknown. As with other cancers, smoking is considered a risk factor for leukemia, but many people who develop leukemia have never smoked, and many people who smoke never develop leukemia. Long-term exposure to chemicals such asbenzene or formaldehyde, typically in the workplace, is considered a risk factor for leukemia, but this accounts for relatively few cases of the disease. Prolonged exposure to radiation is a risk factor, although this accounts for relatively few cases of leukemia. Doses of radiation used for diagnostic imaging such as x-raysand CT scans are nowhere near as prolonged or high as the doses needed to cause leukemia. Other risk factors for leukemia include the following: Previous chemotherapy: Chemotherapy, particularly certain of the alkylating agents and topoisomerase inhibitors, used to treat certain types of cancers, are linked to development of leukemia later. It is likely that radiation treatment adds to the risk of leukemia associated with certain chemotherapy drugs. Human T-cell leukemia virus 1 (HTLV-1): Infection with this virus is linked to human Tcell leukemia. Myelodysplastic syndromes: In this unusual group of blood disorders, the net outcome is invariably an acute myelocytic process. Down syndrome and other genetic diseases: Some abnormal chromosomes may increase risk for leukemia. diseases caused by

Family history: Having a first-degree relative (parent, brother, sister, or child) who has chronic lymphocytic leukemia increases ones risk of having the disease by as much as 4 times that of someone who does not have an affected relative.

Leukemia FAQ - Frequently Asked Questions

What is leukemia? Leukemia is a cancer of the blood, caused by a mutation in a cell of the bone marrow. What is bone marrow? Bone marrow is a spongy tissue inside larger bones that produces three types of blood cells; red blood cells, white blood cells, and platelets. What do these blood cells do? Red blood cells carry oxygen throughout the body, white blood cells fight infection and disease, and platelets help the blood clot. How does leukemia affect bone marrow? Leukemia is the result of a mutation in the bone marrow that causes it to produce too many or too few blood cells, which causes many illnesses. Is leukemia fatal? Despite medical advancements and modern treatment, leukemia is still one of deadliest cancers. Who gets leukemia? Leukemia can affect anyone at any age, but is more likely to strike the very young and people past 40. What are the symptoms of leukemia? Leukemia is very difficult to diagnose, mostly because its symptoms are easily confused with other, less dangerous conditions. Common signs of leukemia include: Fever, chills or flu-like symptoms Night sweats Weakness and fatigue Loss of appetite and/or weight Easy bleeding or bruising Bone or joint pain Paralysis Tiny red spots under the skin Swollen or bleeding gums Swollen lymph glands Seizures due to involvement of the brain (acute leukemias) Unfortunately, leukemias can go undiagnosed since a fever, nausea, sleeplessness, and loss of appetite are easily attributable to a cold or the flu. Also, different types of leukemia cause different symptoms. How is leukemia treated? Leukemia is usually treated with drugs, radiation, and immunotherapy, which aims to increase the natural disease fighting powers of the body.

What should people do if diagnosed with a benzene-related disease? Victims should follow all the directions of their physicians and seek crucial emotional support immediately. They should also contact a benzene lawyer to pursue legal action against the party responsible for their injuries. Are there time constraints for filing a benzene suit? Absolutely, individual states have laws called statues of limitations, which vary from state to state and limit how much time victims can initiate legal action. In benzene litigation, this window of opportunity usually begins immediately after a diagnosis and lasts only a few years. If I win my lawsuit, what does the potential compensation award cover? The compensation you could potentially receive can cover the mounting medical bills resulting from tests and treatment for your illness, the pain and emotional anguish experienced by you and your family, and financial security for your family if the illness ultimately takes your life. How can I afford to pay a lawyer? Most leukemia lawyers work on a contingency basis, which means they don't get paid unless you do. This ensures they will devote all their energy to winning your case and fighting for the financial compensation that you deserve.

3.14.6. Check Your Progress

1. Describe the term Acute leukemia & Chronic leukemia 2. What are the symptoms of leukemia?

3.14.7. Glossary
Acute lymphocytic leukemia (ALL): most common in young children and older adults. It is caused by rapid overproduction of white blood cells. Acute myelogenous leukemia (AML): most common adult leukemia. It is caused by rapid overproduction of undifferentiated bone marrow stem cells. Anemia: a condition caused by too few red blood cells that usually results in fatigue and poor health. Aplastic anemia: a condition where the bone marrow produce too few of the three types of blood cells. Bone Marrow: A spongy tissue within larger bones made up of stem cells that grow into white blood cells, red blood cells, and platelets. Bone Marrow Transplant: A complicated and dangerous procedure that involves taking bone marrow from a healthy donor and injecting it into a leukemia patient. Chemotherapy: medical treatment that uses specially designed drugs to kill cancerous cells or inhibit their growth.

Chronic lymphocytic leukemia (CLL): longer term over-production of white blood cells, most common in people over 65. Chronic myelogenous leukemia (CML): long term over-production of immature blood cells. Graft vs. Host disease: a dangerous side effect of a bone marrow transplant. In normal organ transplants, the host body immune system can reject the foreign tissues, but in bone marrow transplants the new antibodies provided by the new bone marrow reject the host body. Leukemia: Cancer of the bone marrow. Metastasis: when cancerous cells from one tissue invade and kill other tissues. Non-Hodgkin's lymphoma: a cancer of the immune system whereby cells in lymph nodes abnormally reproduce which eventually leads to tumors that spread throughout the body. Radiation therapy: use of high energy radiation that kills cancerous cells and prevents them from spreading. Red blood cells: Responsible for providing oxygen to tissues and organs. Platelets: Responsible for blood clotting. Stem cells: unspecialized cells that the body used to create other cells; for instance bone marrow uses stem cells to produce blood cells. White blood cells: Responsible for fighting off infection and disease in the body.

3.14.8. Reference
Leukemia By Wendy HU. MD. Leukemia By Clarence Sarkodee Adoo MD Mary L Windle PharmD

3.14.9. Answer to Check Your Progress

1. Read 3.14.2. 2. Read 3.14.5

SECTION 3 Unit-15 Features of different Type of leukemias, with reference to clinical states
3.15.1. Objective 3.15.2. Common types of leukemias & treatments 3.15.3. Summary 3.15.4. Check Your Progress 3.15.5. Glossary 3.15.6. Reference 3.15.7. Answer to check your progress

3.15.1. Objective
Here we briefly analyzed about various types of leukemias and treatments.

3.15.2. Common Types of Leukemias

The four most common types of leukemia are: Acute myeloid leukemia (AML) Acute lymphoblastic leukemia (ALL) Chronic myeloid leukemia (CML) Chronic lymphocytic leukemia (CLL) Each main type of leukemia is named according to the type of cell that's affected (a myeloid cell or a lymphoid cell) and whether the disease begins in mature or immature cells. Other types of leukemia and related disorders include: Hairy cell leukemia Chronic myelomonocytic leukemia (CMML) Juvenile myelomonocytic leukemia (JMML) After diagnosis and treatment, many people with leukemia live many good, quality years. You may find that knowing more about the disease and its treatment can help you cope.

A- Acute myeloid leukemia

Acute myelogenous leukemia; AML; Acute granulocytic leukemia; Acute nonlymphocytic leukemia (ANLL); Leukemia - acute myeloid (AML); Leukemia - acute granulocytic; Leukemia - nonlymphocytic (ANLL) Acute myeloid leukemia (AML) is cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells. The cancer grows from cells that would normally turn into white blood cells.

Acute means the disease develops quickly. Causes, incidence, and risk factors Acute myeloid leukemia (AML) is one of the most common types of leukemia among adults. This type of cancer is rare under age 40. It generally occurs around age 60. (This article focuses on AML in adults.) AML is more common in men than women. Persons with this type of cancer have abnormal cells inside their bone marrow. The cells grow very fast, and replace healthy blood cells. The bone marrow, which helps the body fight infections, eventually stops working correctly. Persons with AML become more prone to infections and have an increased risk for bleeding as the numbers of healthy blood cells decrease. Most of the time, a doctor cannot tell you what caused AML. However, the following things are thought to lead to some types of leukemia, including AML: Certain chemicals (for example, benzene) Certain chemotherapy drugs, including etoposide and drugs known as alkylating agents Radiation Problems with your genes may also play a role in the development of AML. You have an increased risk for AML if you have or had any of the following: A weakened immune system (immunosuppressant) due to an organ transplant Blood disorders, including: o Polycythemia vera o Essential thrombocythemia o Myelodysplasia (refractory anemia) Exposure to radiation and chemicals

Symptoms Bleeding from the nose Bleeding gums Bruising Bone pain or tenderness Fatigue Fever Heavy menstrual periods Pallor Shortness of breath (gets worse with exercise) Skin rash or lesion Swollen gums (rare) Weight loss Signs and tests

The doctor will perform a physical exam. There may be signs of a swollen spleen, liver, or lymph nodes. A complete blood count (CBC) shows anemia and a low number of platelets. A white blood cell count (WBC) can be high, low, or normal. Bone marrow aspiration will show if there are any leukemia cells. If your doctor learns you do have this type of leukemia, further tests will be done to determine the specific type of AML. There are eight subtypes of AML. They range from M0 to M7, based on which blood cells are abnormal. Treatment Treatment involves using medicines to kill the cancer cells. This is called chemotherapy. But chemotherapy kills normal cells, too. This may cause side effects such as excessive bleeding and an increased risk for infection. Your doctor may want to keep you away from other people to prevent infection. Other treatments for AML may include: Antibiotics to treat infection Bone marrow transplant or stem cell transplant after radiation and chemotherapy Red blood cell transfusions to fight anemia Transfusions of platelets to control bleeding

Most types of AML are treated the same way. However, a form of AML called acute promyelocytic leukemia (APL) is treated with a medicine called all-trans retinoic acid (ATRA). This medicine helps leukemia cells grow into normal white blood cells. The drug arsenic trioxide is for use in patients with APL who do not get better with ATRA or chemotherapy.

B- Acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is a form of leukemia, or cancer of the white blood cells characterized by excess lymphoblasts. Malignant, immature white blood cells continuously multiply and are overproduced in the bone marrow. ALL causes damage and death by crowding out normal cells in the bone marrow, and by spreading (infiltrating) to other organs. ALL is most common in childhood with a peak incidence at 25 years of age, and another peak in old age. The overall cure rate in children is about 80%, and about 45%-60% of adults have long-term disease-free survival. Acute refers to the relatively short time course of the disease (being fatal in as little as a few weeks if left untreated) to differentiate it from the very different disease of chronic lymphocytic leukemia which has a potential time course of many years. It is interchangeably referred to as Lymphocytic or Lymphoblastic. This refers to the cells that are involved, which if they were

normal would be referred to as lymphocytes but are seen in this disease in a relatively immature (also termed 'blast') state. Diagnosis Diagnosing ALL begins with a medical history, physical examination, complete blood count, and blood smears. Because the symptoms are so general, many other diseases with similar symptoms must be excluded. Typically, the higher the white blood cell count, the worse the prognosis. Blast cells are seen on blood smear in majority of cases (blast cells are precursors (stem cells) to all immune cell lines). A bone marrow biopsy is conclusive proof of ALL. A lumbar puncture (also known as a spinal tap) will tell if the spinal column and brain has been invaded. Pathological examination, cytogenetics (particularly the presence of Philadelphia chromosome) and immunophenotyping, establish whether the Myeloblastic (neutrophils, eosinophils or basophils) or Lymphoblastic (B lymphocytes or T lymphocytes) cells are the problem. RNA testing can establish how aggressive the disease is; different mutations have been associated with shorter or longer survival. Immunohistochemical testing may reveal TdT or CALLA antigens on the surface of leukemic cells. TdT is a protein expressed early in the development of pre-T and pre-B cells while CALLA is an antigen found in 80% of ALL cases and also in the "blast crisis" of CML. Medical imaging (such as ultrasound or CT scanning) can find invasion of other organs commonly the lung, liver, spleen, lymph nodes, brain, kidneys and reproductive organs

C- Chronic myeloid leukemia

Chronic myeloid leukemia (CML), also known as chronic myelogenous leukemia, is a type of cancer that starts in the blood-forming cells of the bone marrow and invades the blood. In CML, leukemia cells tend to build up in the body over time, but in many cases people don't have any symptoms for at least a few years. In time, the cells can also invade other parts of the body, including the spleen. CML can also change into a fast-growing acute leukemia that invades almost any organ in the body. Most cases of CML occur in adults, but very rarely it occurs in children, too. In general, their treatment is the same as for adults. Leukemia is different from other types of cancer that start in organs such as the lungs, colon, or breast and then spread to the bone marrow. Cancers that start elsewhere and then spread to the bone marrow are not leukemia. Normal bone marrow, blood, and lymphoid tissue To understand the different types of leukemia, it helps to have some basic knowledge about the blood and lymph systems. The information which follows is quite complex. It may prove helpful, but you don't need to understand all of it to learn more about your leukemia.

Bone marrow Bone marrow is the soft inner part of some bones such as the skull, shoulder blades, ribs, pelvis, and backbones. The bone marrow is made up of a small number of blood stem cells, more mature blood-forming cells, fat cells, and supporting tissues that help cells grow. The blood-forming cells come from blood stem cells. These stem cells only make new bloodforming cells, not other kinds of cells. (This makes them different from embryonic stem cells, which form in a developing fetus and can develop into most other cells in the body.) Stem cells go through a series of changes. During this process, the cells develop into cells that become lymphocytes (a kind of white blood cell) or into cells that form other cells found in blood. These other cells include red blood cells, white blood cells (other than lymphocytes), or platelets. Red blood cells Red blood cells carry oxygen from the lungs to all other tissues in the body and take carbon dioxide back to the lungs to be removed. Not having enough red blood cells in the body is called anemia. Symptoms of anemia include weakness, fatigue, and shortness of breath because the body tissues are not getting enough oxygen. Platelets Platelets aren't actually whole cells, but instead are pieces of large cells found in the bone marrow called megakaryocytes. Platelets are important in plugging up holes in blood vessels caused by trauma. A shortage of platelets is calledthrombocytopenia, and can lead to problems with easy bruising and bleeding. White blood cells
White blood cells are important in defending the body against infections. Lymphocytes are one type of white blood cell. The other types of white blood cells are granulocytes and monocytes.

Lymphocytes are the main cells that make up lymphoid tissue, a major part of the immune system. Lymphoid tissue is found in lymph nodes, the thymus gland, the spleen, the tonsils, and the adenoids. It is also scattered throughout the digestive and respiratory systems and the bone marrow. Lymphocytes develop from cells called lymphoblasts to become mature, infection-fighting cells. The 2 major types of lymphocytes are known as B lymphocytes (B cells) and T lymphocytes (T cells). B lymphocytes protect the body from invading germs by developing (maturing) into plasma cells, which make antibodies. These antibodies attach to the germs, such as bacteria, viruses, and fungi. Once the germ has been coated in this way, it can be targeted by other parts of the immune system and be destroyed. T lymphocytes can recognize cells infected by viruses and directly destroy these cells. Granulocytes develop from blood-forming cells called myeloblasts to become mature, infectionfighting cells. These white blood cells are called granulocytes because they contain granules, which can be seen as spots in the cells when they are looked at under the microscope. These granules contain enzymes and other substances that can destroy germs such as bacteria. The 3 types of granulocytes -- neutrophils, basophils, and eosinophils -- are distinguished by the size

and color of their granules. Neutrophils are the most common type of granulocyte in the blood. They are essential in destroying bacteria that have invaded the blood. Monocytes are related to granulocytes and are important because they protect the body against bacteria. They start in the bone marrow as blood-forming monoblasts and develop into mature monocytes. Monocytes circulate in the bloodstream for about a day and then they enter body tissues to become macrophages. These microphages can destroy some germs by surrounding and digesting them. Macrophages are also important because they help lymphocytes recognize germs and start making antibodies to fight them.

D- Chronic lymphocytic leukemia

Causes Chronic lymphocytic leukemia (CLL) causes a slow increase in white blood cells called B lymphocytes, or B cells. The cancerous cells spread from the blood marrow to the blood, and can also affect the lymph nodes or other organs such as the liver and spleen. CLL eventually causes the bone marrow to fail. IThe cause of CLL is unknown. There is no link to radiation, cancer-causing chemicals, or viruses. This cancer mostly affects adults, around age 70. It is rarely seen under age 40. The disease is more common in Jewish people of Russian or East European descent. Symptoms Symptoms usually develop slowly over time. Many cases of CLL are detected by blood tests done in people for other reasons or who do not have any symptoms. Symptoms that can occur include: Abnormal bruising (occurs late in the disease) Enlarged lymph nodes, liver, or spleen Excessive sweating, night sweats Fatigue Fever Infections that keep coming back (recur) Loss of appetite or becoming full too quickly (early satiety) Unintentional weight loss

Exams and Tests Patients with CLL usually have a higher-than-normal white blood cell count. Tests to diagnose and assess CLL include: Complete blood count (CBC) with white blood cell differential Bone marrow biopsy CT scan of the chest, abdomen, and pelvis

 Immunoglobulin testing Lactate dehydrogenase test If your doctor discovers you have CLL, tests will be done to see how much the cancer has spread. This is called staging. There are two systems used to stage CLL: The Rai system uses numbers 0 to IV to group CLL into low-, intermediate-, and highrisk categories. Generally, the higher the stage number, the more advanced the cancer. The Binet system uses letters A-C to stage CLL according to how many lymph node groups are involved and whether you have a drop in the number of red blood cells or platelets.

Some newer tests look at the chromosomes inside the cancer cells. The results can help your doctor better determine your treatment. Treatment No treatment is usually give for early stage CLL. However, the patient must be closely monitored by their health care provider. If chromosome testing suggests that you have a high-risk type of CLL, treatment may be started earlier. Treatment may also be started if: Infections keep coming back Leukemia is growing rapidly. Low blood counts (anemia and thrombocytopenia (low platelet count) are present Fatigue, loss of appetite, weight loss, or night sweats occur Several chemotherapy drugs are commonly used to treat CLL. Fludarabine, chlorambucil, cyclophosphamide (Cytoxan), and rituximab (Rituxan) may be used alone or in combination. Alemtuzumab (Campath) is approved for treatment of patients with CLL that have not responded to fludarabine. Bendamustine is a newer drug recently approved for use in patients with CLL that has come back after initial treatment. Rarely, radiation may be used for painfully enlarged lymph nodes. Blood transfusions or platelet transfusions may be required if blood counts are low. Bone marrow or stem cell transplantation may be used in younger patients with advanced or high-risk CLL. A transplant is the only therapy that offers a potential cure for CLL. Outlook (Prognosis)

How well a patient does depends on the stage of the cancer. About half of patients diagnosed in the early stages of the disease live more than 12 years. Possible Complications Autoimmune hemolytic anemia Bleeding from low platelet count Hypogammaglobulinemia, a condition in which you have lower levels of antibodies, which increases your risk of infection Idiopathic thrombocytopenic purpura (ITP) Infections that keep coming back (recur) Overwhelming fatigue Other cancers, including a much more aggressive lymphoma (Richters transformation) Side effects of chemotherapy

3.15.3. Summary
Leukaemia is a cancer of blood-forming cells in the bone marrow. Large numbers of white blood cells are produced, which crowd the bone marrow and can affect the production of normal cells. There are four main types of leukaemia. In many cases, leukaemia can be cured or kept under control. Chemotherapy is the main treatment. Leukaemia is a cancer of the blood-forming cells, which are made in the bone marrow. Leukaemia causes large numbers of white blood cells to be produced. This can crowd the bone marrow and may affect the production of normal cells. A person with leukaemia may be more likely to pick up infections and have trouble getting rid of them. Just over 750 Victorians develop leukaemia every year. There are four main types of leukaemia. In many cases, leukaemia can be cured or kept under control for many years. Chemotherapy is the main treatment. Large numbers of abnormal white cells Blood is mostly made up of plasma, which is a clear fluid. Floating in this fluid are three types of cells: Red blood cells that carry oxygen around the body White blood cells that fight disease and infection Platelets that help to stop bleeding when it starts. Blood cells are made in the bone marrow, which is the spongy part in the centre of the bone. When the body is healthy, the numbers of red cells, white cells and platelets in the blood are kept in balance. In people with leukaemia, the bone marrow makes too many abnormal white blood cells. These abnormal cells are unable to carry out their normal function and can crowd the bone marrow. This means that there is not enough room in the bone marrow for making normal white blood cells, red blood cells and platelets.

White blood cells normally help to fight infection. In a person with leukaemia, a large number of these cells are abnormal. If a person has too many abnormal white blood cells, they are more likely to pick up and have trouble getting rid of infections. Risks and causes of leukaemia The cause of most cases of leukaemia is unknown. There are several risk factors that may increase your chance of developing this disease. The main ones are: Exposure to intense levels of radiation no cases of leukaemia has been linked to radiation from x-rays and CT scans. Exposure to the chemical benzene in a work environment over long periods of time. Cigarette smoking this can increase your risk of some types of leukaemia. Genetic factors certain inherited conditions can increase your risk of developing some types of leukaemia. Family history, age and gender these can all have an effect on your risk of developing certain types of leukaemia. Research into further possible causes is ongoing. Types of leukaemia There are different types of leukaemia and the treatment for each is different. The condition may: Develop suddenly (over days or weeks) this is called acute leukaemia Develop over months or years this is called chronic leukaemia Involve either the myeloid or lymphoid cells the condition is named for the type of blood cell affected. Most common types of leukaemia There are four main types of leukaemia. Leukemia is a disease that affects blood forming cells. It begins in the bone marrow and is characterized by an abundance of white blood cells in the body. Leukemia can be divided in to 4 types. It is first classified as acute or chronic. Chronic Leukemias In chronic leukemia, the leukemia cells come from mature, abnormal cells. The cells thrive for too long and accumulate. The cells grow slowly. Acute Leukemias Acute leukemia, on the other hand, develops from early cells, called "blasts". Blasts are young cells that divide frequently. In acute leukemia cells, they don't stop dividing like their normal counterparts do. The remain two types refer to the type of cells in which the leukemia started from. Myelogenous Leukemia Myelogenous leukemia develops from myeloid cells. The disease can either be chronic or acute, referred as chronic myelogenous leukemia (CML), or acute myelogenous leukemia (ALL). Lymphocytic Leukemia

Lymphocytic leukemia develops from cells called lymphoblasts or lymphocytes in the blood marrow. The disease can be acute or chronic, referred as chronic lymphocytic leukemia (CLL), or acute lymphocytic leukemia (ALL).

3.15.4. Check Your Progress

1. What are the two systems used to stage CLL? 2. What are the four most common types of leukemia? 3. What are the 2 major types of lymphocytes?

3.15.5. Glossary
Leukaemia is a cancer that starts in blood-forming tissue such as the bone marrow, which makes blood cells (red blood cells that carry oxygen around the body, white blood cells that fight disease and infection, platelets that help to stop bleeding when it starts). In people with leukaemia, the bone marrow produces large numbers of abnormal white blood cells and not enough normal red blood cells. Leukemia cases represent less than 4% of all cancer cases in adults but are the most common form of cancer in children. Different types of leukaemia. Those that develop suddenly (over days or weeks) are called acute leukemias. Leukemias that develop over months or years are chronic leukemias. Leukemia is also named by the type of white blood cell affected, either the myeloid or lymphoid cells, which are distinguished by their appearance under the microscope. Myeloid white blood cells are the immune system's first line of defence against infection and are found mainly in the blood. [They] engulf and kill foreign organisms. Lymphoid white blood cells are found in the lymph nodes and in the blood. They lie in wait to detect foreign organisms and stimulate the body's defences to fight them. Blood tests to check for large numbers of abnormal white blood cells. Bone marrow biopsy a small amount of fluid is taken from the bone marrow using a needle. The samples are then examined under a microscope. This test can help work out which type of leukemia is present. Lymph node biopsy a small amount of tissue is removed with a needle from a swollen lymph node. It is examined under a microscope. Lumbar puncture fluid is removed with a needle from a space between the bones in the back. The fluid is looked at under a microscope.

3.15.6. Reference
Leukemia By Wendy HU. MD. Leukemia By Clarence Sarkodee Adoo MD Mary L Windle PharmD Leukemia Research Home Better Health

3.15.7. Answer to check your progress

1. Read 3.15.2. D 2. Read 3.15.2 A 3. Read 3.15.2.C

SECTION 3 Unit-16 Diagnosis of different types of leukaemias

3.16.1. Objective 3.16.2. Leukemias symptoms 3.16.3. Diagnosis leukemias 3.16.4. Summary 3.16.5. Check Your Progress 3.16.6. Glossary 3.16.7. Reference 3.16.8. Answer to Check Your Progress

3.16.1. Objective
We studied about various symptoms of leukemias and various diagnosis methods, Treatments and Baby Leukemia and Treatments for Childhood Leukemia

3.16.2. Leukemias Symptoms

Leukemia is a blood cancer that is commonly thought of as a disorder that primarily affects children. According to the Mayo Clinic, while some forms of leukemia do affect children, it is a disease that can strike anyone at any age. The most common ways used to diagnose leukemia are a blood sample, a bone marrow sample and a physical examination. Identification Leukemia is a cancer that causes the bone marrow to create a large number of dysfunctional white blood cells. White blood cells are very important to the general health of the body as they are the primary cells used to fight disease. Bone marrow that is affected by leukemia will produce white blood cells that are incapable of fighting disease, and the over-abundance of defective white blood cells starts to have an adverse affect on the blood stream which causes serious problems for the rest of the body. Effects Leukemia has different forms that display slightly different symptoms in most cases. However there is a series of symptoms that are commonly displayed in most leukemia patients. Flu-like symptoms such as a fever accompanied by the chills, excessive sweating especially at night, a general achy feeling all over the body and fatigue could all be early signs of leukemia. Other early symptoms include the tendency to bruise easily, persistent infections that do not seem to go away, a loss of appetite accompanied by a noticeable loss of weight and a shortness of breath after brief physical activity.

Types Acute leukemia is a form of leukemia that can strike quickly and appear to progress at a very rapid pace. The symptoms may seem to worsen over a period of days, and the most commonly affected areas would be the brain and the spine. Some of the symptoms of acute leukemia include a nausea accompanied by vomiting, severe headaches, an unexplained loss of muscle control and vision problems such as temporary blindness or blurred vision. Unexplained and painful red rashes with open sores may also develop rapidly. Considerations Chronic leukemia may take months, or even years, to show symptoms. According to the University of California, it is common for a doctor to find chronic leukemia as the result of a standard medical exam before any symptoms are even shown. When symptoms become evident, they will start off minor, and then gradually grow into more severe symptoms. Some of the symptoms include nausea and vomiting and a skin rash that starts of in a small localized area, then slowly grows to a larger size over time. Prevention/Solution Treating leukemia may require a combination of treatments. Some of the more common treatments used to combat the condition are chemotherapy medication, radiation treatment and a bone marrow transplant. A doctor will determine which treatment is appropriate based on whether the condition is acute or chronic and how far the condition has advanced. Leukemia is a condition that creates an abnormally high amount of white blood cells that are unable to do their job of disease prevention. These cells become cancerous and continue to multiply. It is important to diagnose leukemia as early as possible before the cancerous cells begin to spread to the internal organs. Leukemia is treated with a combination of chemotherapy medication, radiation treatment, and a bone marrow transplant. Flu-Like Symptoms Some of the more common symptoms of leukemia are flu-like symptoms. These include a high fever, sweating, chills, and a general achy feeling. The fever is an indication of a bacterial infection which would also cause symptoms such as a runny nose and a headache. It is also possible to feel a general feeling of fatigue or weakness that may be accompanied by a loss of appetite. Lumps and Swelling Leukemia also creates lumps as a symptom. In some cases these lumps are clearly visible, and in other cases they can be felt but not seen. The most common places for lumps to appear are the abdomen, the groin, the underarm area, and around the eyes. These lumps are painless. Pain may occur in areas accompanied by swelling. In some cases of leukemia the liver or the spleen may enlarge, and this would cause painful swelling just under the rib cage closer to the back. Coughing Leukemia causes lymph nodes in your neck and chest to start swelling. This swelling may be noticeable and should be considered a symptom. Swelling lymph nodes in the chest and neck

may also cause a chronic cough, and it could also cause shortness of breath even from the more remedial of physical activities. Blood Test A blood test is commonly performed to diagnose leukemia. The blood test results are analyzed for white blood cell count, red blood cell count and platelet count. Leukemia will cause an abnormally high white blood cell count, an abnormally low count of platelets and a low count of red blood cells. To diagnose leukemia the white blood cell count and platelet count are primarily used. Bone Marrow Aspiration The bone marrow needs to be analyzed to properly diagnose leukemia. To extract the bone marrow needed for testing a bone marrow aspiration is used. A large needle is injected directly into the bone marrow and a sample is taken. In some cases a bone marrow biopsy may be done which is the process of taking a marrow sample and an actual bone sample. There may also be a spinal tap done to see if the leukemia has spread to the spinal fluid and made its way to the brain. A spinal tap is done with a long needle at the base of the spine.

3.16.3. Diagnosis of different types of leukemias

Diagnosis Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what's causing the problems. Your doctor may ask about your personal and family medical history. You may have one or more of the following tests: Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver. Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells. Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells. There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit: Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow. Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Other Tests The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests: Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome. Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems. Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

Baby Leukemia Symptoms

Leukemia is cancer of the white blood cells. It is the most common childhood cancer. The National Institute of Health says the most prevalent type of leukemia in children of all ages is acute lymphocytic leukemia (ALL). The majority of the symptoms associated with childhood leukemia are due to an inadequate supply of normal blood cells. Risk Factors The National Cancer Institute says risk factors for childhood leukemia include having a sibling with the disease, inheriting certain genetic disorders and prior exposure to radiation or chemotherapy treatments. According to the Mayo Clinic, infants and children over age 10 are considered at a higher risk of developing leukemia. ALL When leukemia has been termed "acute" it means the disease is developing at an accelerated pace and if left untreated would most likely be fatal in a few months. ALL is a cancer that starts from white blood cells called lymphocytes in the bone marrow, where new blood cells are created. About 75 percent of childhood leukemia cases are of the ALL variety. AML Acute myelogenous leukemia (AML) make up most of the remaining 25 percent of childhood leukemia case. AML leukemia develops in the cells that form white blood cells (other than lymphocytes), red blood cells, or platelets. Many of the signs and symptoms of leukemia provided by the American Cancer Society can also be due other problems.

Fatigue, Fever & Infection A child with leukemia may be very tired and experience a shortness of breath. He or she may also have a high fever and an infection that fails to heal with antibiotics. Increased Proneness to Bruising & Bleeding A child with leukemia may bruise easily, and there may be bleeding from the gum's as well as small red spots on the skin caused by bleeding from tiny blood vessels. They may also have periods of excessive coughing. Swelling of the Face, Arms & Lymph Nodes As leukemia cells grow and multiple they may begin to push on a large vein that transports blood from the head and arms to the heart. This pressure can result in swelling of the head, arms and upper chest. If leukemia has spread to the lymph nodes, there may be swelling on the sides of the neck, under the arms, in the groin and possibly above the collarbone. Treatment Unlike most other cancers, surgery is not a conventional method of treating leukemia. Because leukemia is a disease of blood and bone marrow, it cannot be cured or managed with surgery. Childhood leukemia is generally treated with a combination of chemotherapy and radiation. The doses and length of treatment will vary depending on the type of leukemia that's been diagnosed. Bone marrow and blood stem cell transplantation may be used in some cases.

Treatments for Childhood Leukemia

Leukemia is a form of cancer that occurs in the bone marrow, an area in the center of the bones that produces blood cells. In 2009, The Leukemia and Lymphoma Society expects 3,509 American children under the age of 15 will be diagnosed with leukemia. Treatment options vary by the type of leukemia and its level of progression. Identification When a child develops leukemia, his bone marrow makes too many abnormal white blood cells. White blood cells are normally used to fight infection, but illness can result when an overabundance of abnormal cells are produced. Oxygen-rich red blood cells and platelets, essential to blood clotting, are also produced by bone marrow. When leukemia occurs, white blood cells grow at an uncontrollable rate, decreasing the number of healthy red blood cells and platelets available. The combination of too many white blood cells and not enough red blood cells and platelets may cause such symptoms as weight loss, weakness, fatigue, loss of appetite, frequent infections, bruising, swollen lymph nodes, anemia, night sweats, and joint or bone pain. Leukemia treatment is aimed at restoring the balance between red and white blood cells. Types Types of leukemia found in children include Acute lymphocytic leukemia (ALL), chronic myeloid leukemia, (CML), acute myeloid leukemia and juvenile myelomoncytic leukemia. ALL

is the most commonly diagnosed form of childhood leukemia, according to the American Cancer Society. When children develop leukemia, they are more likely to develop an acute, or rapidly progressing, form of the disease. Induction Chemotherapy Combination chemotherapy is the primary treatment for leukemia. Drugs are taken in pill form or are given through an intravenous drip and work by targeting and killing rapidly dividing cancer cells. The first phase of treatment begins with induction, during which the child receives a combination of several drugs. The type of chemotherapy drugs used depends on the type of leukemia that your child has. After induction, most of the leukemia cells may be killed in the bone marrow, putting your child into remission. Intrathecal Chemotherapy Chemotherapy drugs may also be injected into the cerebrospinal fluid that runs through the spinal cord in order to kill any leukemia cells that may have spread to the spinal cord or brain. This type of treatment, called intrathecal chemotherapy, has a slight risk of causing epileptic seizures. Radiation Therapy In some cases, radiation therapy may be needed in conjunction with intrathecal treatment. Radiation therapy is usually used for children with an extremely high white blood cells count, those with leukemia cells in the spinal fluid and older children. During radiation therapy, your child receives high doses of radiation that kill cancer cells, and reduces the size of an enlarged spleen or swollen lymph nodes. Consolidation and Maintenance Chemotherapy Consolidation, the most intense part of chemotherapy treatment, uses a new combination of drugs, depending on the form of the disease. Treatment is aimed at killing remaining leukemia cells. Maintenance therapy may be used for several months or years after the initial rounds of therapy. Lower doses of chemotherapy are used for this form of therapy, which is helpful in preventing recurrences. Bone Marrow Transplants If other treatments don't reduce the number of white cells or the leukemia has recurred, a bone marrow transplant may be needed. During a bone marrow transplant, your child will receive stem cells, immature blood cells that are taken from a donor, from your child before cancer treatment begins or from the umbilical cord of an infant. The goal of a bone marrow transplant is to replace diseased bone marrow with healthy marrow, with the hope that the healthy bone marrow will begin producing normal cells.

3.16.4. Summary
Diagnosis of leukaemia Tests to help diagnose leukaemia may include: Blood tests to check for large numbers of abnormal white blood cells. Bone marrow biopsy a small amount of fluid is taken from the bone marrow using a needle. The samples are then examined under a microscope. This test can help work out which type of leukaemia is present. Lymph node biopsy a small amount of tissue is removed with a needle from a swollen lymph node. It is examined under a microscope. Lumbar puncture fluid is removed with a needle from a space between the bones in the back. The fluid is looked at under a microscope. If these tests show that you do have leukaemia, you may also need to have further blood and bone marrow tests as well as some scans (CT, ultrasound or MRI). Test results can take a few days to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling. You could also contact the Cancer Council Helpline on 13 11 20 and speak with a cancer nurse. Treatment of leukaemia Most children and many adults with acute leukaemia can expect to be cured. For most people, chronic leukaemia can be successfully managed for long periods of time. Treatment depends on the type of leukaemia, but may include: Chemotherapy drugs to treat cancer by destroying or slowing the growth of fastgrowing cancer cells. These are usually given intravenously, but may sometimes be given as tablets. For some people, chemotherapy for acute leukaemia will mean spending several weeks in hospital. Others may be able to stay at home but will need regular hospital check-ups and further treatments. Stem cell transplant (stem cells are immature white blood cells) a transplant allows you to have much higher doses of chemotherapy than usual. This helps improve the chances of curing some types of leukaemia or of prolonging remission. The high doses of chemotherapy, sometimes given with total body irradiation (TBI), destroy the bone marrow and stem cells. After the high-dose treatment, you will be given a drip (infusion) of either your own stem cells (autologous transplant) or stem cells from a donor (allogeneic transplant). Biological therapy also known as immunotherapy. This is the use of substances that are naturally produced within the body to encourage the immune system to fight disease. Interferon and growth factors are used to treat leukaemia. Radiotherapy may be used for different types of leukaemia to help control symptoms as part of intensive treatment regimes, or to treat cancer that has spread to the brain or spinal cord. Steroids research has shown that treatment for some types of leukaemia is better if steroids are given alongside the chemotherapy.

All-trans-retinoic acid this is a form of vitamin A used to treat a type of acute myeloid leukaemia. It is usually taken as tablets with chemotherapy. Complementary and alternative therapies when used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve quality of life. Others may not be so helpful and in some cases may be harmful. Details of the Cancer Council Victorias booklet Complementary and alternative cancer therapies are in the Where to get help section.

All treatments have side effects. These will vary depending on the type of treatment you are having. Many side effects are temporary but some may be permanent. Your doctor will explain all the possible side effects before your treatment begins. When a cure isn't possible If leukaemia has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving the symptoms (this is called palliative treatment). Medications can be used to relieve pain, nausea and vomiting.

3.16.5. Check Your Progress

What are the different signs and symptoms of leukemia provided by the American Cancer Society How to diagnosis Baby Leukemia Symptoms and treatments

3.16.6. Glossary
Blood count: The calculated number of white or red blood cells (WBCs or RBCs) in a cubic millimeter of blood. Blood transfusion: The transfer of blood or blood components from one person (the donor) into the bloodstream of another person (the recipient). This may be done as a lifesaving maneuver to replace blood cells or blood products lost through bleeding. Transfusion of your own blood (autologous) is the safest method but requires advance planning and not all patients are eligible. Directed donor blood allows the patient to receive blood from known donors. Volunteer donor blood is usually most readily available and, when properly tested has a low incidence of adverse events. Blood conserving techniques are an important aspect of limiting transfusion requirements. Bone marrow: The soft blood-forming tissue that fills the cavities of bones and contains fat and immature and mature blood cells, including white blood cells, red blood cells, and platelets. Diseases or drugs that affect the bone marrow can affect the total counts of these cells. Bone marrow aspiration: The removal of a small amount of bone marrow (usually from the hip) through a needle. The needle is placed through the top layer of bone and a liquid sample containing bone marrow cells is obtained through the needle by aspirating (sucking) it into a

syringe. The suction causes pain for a few moments. Bone marrow aspiration is done to diagnose and follow the progress of various conditions, including anemia and cancer, and to obtain marrow for transplantation. Bone marrow biopsy: The removal of a sample of bone marrow and a small amount of bone (usually from the hip) through a large needle. Two samples are taken. The first is bone marrow by aspiration (suction with a syringe). The second sample is a core biopsy to obtain bone marrow together with bone fibers. After the needle is removed, this solid sample is pushed out of the needle with a wire. Both samples are examined under a microscope to see the cells and architecture of the bone marrow. Bone marrow transplant: A procedure in which bone marrow that is diseased or damaged is replaced with healthy bone marrow. The bone marrow to be replaced may be deliberately destroyed by high doses of chemotherapy and/or radiation therapy.

3.16.7. Reference
Leukemia Symptoms by Arnold Anderson Baby Leukemia Symptoms by Karen Hellisvig Treatments for Childhood Leukemia By Jill Levitus

3.16.8. Answer to Check Your Progress

1. Read 3.16.3. 2. Read 3.16.3.