The blood in leukemia: diagnosed correctly
One of the most rapid and informative methods of diagnosis of leukemia is a common blood test. The study of the blood in leukemia allows to set the kind of disease, stage of its course, and to assign adequate therapy.
What is leukemia?
(Leukemia, blood cancer) is a systemic disease of the blood caused by uncontrolled reproduction and rejuvenation of the hematopoietic elements (leukocytes) without their maturation and persistent transformation of hematopoietic tissue.
The accumulation of immature forms of white blood cells (blasts) occurs both in the bone marrow and in the internal organs and peripheral blood. When this occurs, the replacement of the normal functioning of bone marrow cells (leukocytes, erythrocytes, thrombocytes) leukemia cells (modified cells) are not able to fully participate in immune reactions. As a result, develops cytopenia (shortage of blood cells), and due to the fact that blood vessels located in the body everywhere, is spreading disease throughout the body (metastasis). This entails a rapidly progressive disorder full functioning of all organs and systems.
Causes of leukemia
Leukemia is a multifactorial disease. Each person may have their own factors that cause the development of cancer, among which are:
1. Infectious-viral causes. Viral invasion of the red bone marrow can cause irreversible mutation of cells and their pathological degeneration, which can lead to the development of cancer.
2. Hereditary factors. According to the statistics, the presence of leukemia in any of the immediate family necessarily makes itself felt through one or more generations.
3. Chemical and leucosolenia factors. This means that the leukemia may develop after abuse of some drug, and under the influence of some chemicals for household and industrial use.
4. Radiation factor. It is proved that the radiation damage of chromosomes participates directly in the development of a malignant disease, because the cells that make up the substrate of the tumor, are characteristic of radiation damage.
Clinical practice has shown that leukemia is heterogeneous as clinical manifestations, type of affected white blood cells. The nature of the flow, the leukemia is divided into the following forms:
- Acute leukemia. In this form of cancer there is a loss of young cells (2, 3, at least 4 generations). The disease develops rapidly over a short period of time, the patient developed severe thrombocytopenia, anemia and leukopenia.
- Chronic leukemia. In this form of leukemia there is a loss of Mature or maturing leukocytes. The disease progresses for a long time, reducing the number of normal white blood cells is slow.
The type of the affected white blood cells leukemia is divided into:
- Chronic lymphocytic leukemia. In this form of the disease there is a loss of lymphoid cells. Most often seen in people older than 55 years.
- Chronic myeloid leukemia. In this form of cancer suffer from myeloid cells. The most elderly.
- Acute lymphoblastic leukemia. There is a loss of lymphoid blood cells. There is a very rapid progression of the disease. This is the most common form of blood cancer in children and adolescents. Can develop in older people.
- Acute myeloid leukemia. Cancer of myeloid cells to spread very quickly. This disease affects both children and the elderly.
There are many subtypes of the above major forms of leukemia.
The clinical picture
The symptoms of leukemia are largely determined by the stage of the disease and itsform. The chronic form of blood cancer, usually in the initial stages are asymptomatic and are detected during preventive examination. Acute leukemia begins suddenly and develops rapidly, with symptoms.
Common symptoms of acute and chronic forms of leukemia are:
- The increase in size and tenderness of the lymph nodes in the neck, armpits, groin.
- Causeless periodic fever, night sweats.
- Pain right and left hypochondrium that appear when enlargement of the liver and spleen.
- Frequent infections (bronchitis, pneumonia, cystitis, etc.).
- Fatigue, loss of appetite, weight.
- Pain in bones and joints.
- Frequent bleeding (bleeding gums, nosebleeds, etc.).
Most of the symptoms of blood cancer are not specific, some of them can be caused by various infectious diseases. For this reason, the characteristic of the disease clinical symptoms for diagnosis the patient is assigned a General analysis of peripheral blood.
Blood tests to diagnose leukemia
In case of blood cancer all hematopoietic elements characteristic pathological changes, to detect which allows a General analysis of the blood in leukemia.
In most cases, patients with blood cancer anemia. Anemia is hyperchromic, normochromic or hypochromic in nature and exacerbated with the development of the disease (the concentration of hemoglobin can be reduced to 60-20g/l, and the number of red blood cells to 1.5-1,0h102/l). In the initial period of the disease, anemia may be absent. The number of reticulocytes in leukemia is usually reduced, for example, in acute erythromelas their content does not exceed 10-30%.
Blood count in leukemia shows the presence of thrombocytopenia. The platelet count during the entire period of the disease is subjected to cyclic fluctuations. At the initial stage of cancer, their number can be normal with the progression and exacerbation is reduced (the number of platelets 15-30 g/l), and in the period of remission increases dramatically.
The number of leukocytes in the blood in leukemia can vary from 0.1×109/l 300×109/L. the decrease in the number of leukocytes (leukopenia) is characteristic of acute monoblast leucosis, the initial stage of promyelocytic leukemia and acute erythremic myelosis. But most leukemia occurs with leukocytosis – a significant increase in the number of leukocytes.
In acute leukemia blast cells (myeloblast, lymphoblasts, erythroblasts, etc.) occupy a leading position, their number may be up to 99% of the total number of blood cells. Intermediate forms of leukocytes in leukemia are completely absent or their number is negligible (5%). This condition got its name – "leukemic failure" (absence of transitional forms of leukocytes). This condition is characterized by acute myeloblastic, lymphoblastic, myelomonoblastic forms of the disease.
In chronic leukemia, blasts may be completely absent or their number does not exceed 10% of the total number of cells. There are leukemic failure.
During remission the blood counts in leukemia usually improve. So, in the deployed phase of leukemia the number of blast cells is 20-90%, and in remission – no more than 5%. The content of granulocytes at least 1,5h109/l and platelets — more 100h109/L.
The blood in leukemia the presence of criminal cells does not allow to attribute them to a particular hematopoiesis, however, it is very important to assign adequate therapy. It is therefore advisable conduct cytological and cytochemical studies of blood to determine the phenotype of cells.
So, when cytochemicalthe study of blood in acute leukemia lymphoblasts in the cells indicated a positive reaction to glycogen, peroxidase and lipids, non-specific esterase in blood cells and lysozyme in urine and serum.
Monoblastny in acute leukemia cytochemical study reveals in cells weakly positive reaction to lipids and high activity of nonspecific esterase.
Laboratory diagnosis of leukemia also involves carrying out biochemical analysis of blood. Biochemical analysis of blood in leukemia shows increased activity of LDH, AST, urea, bilirubin, uric acid, gamma-globulin, decreased levels of albumin, fibrinogen, glucose. The severity and character of biochemical changes in the blood tests determine changes in the kidneys, liver and other internal organs.
If the hematopoietic system of the detected violation, the patient is sent for further examination, which includes examination of the punctate of bone marrow biopsy, study of the cerebrospinal fluid, x-rays, of internal organs.
Without a timely start of adequate treatment of leukemia, as a rule, ends in death. Self-treatment when leukemia is very rare, so treatment of the disease should begin immediately after diagnosis.