Acute leukaemia

Last updated: Monday, 25, October, 2010

Key Information	Appropriate Tests
	FBC, blood film, differential WCC; bone marrow aspiration and trephine biopsy. See Table 4. Reference intervals for leucocyte differential counts Cytochemistry, cytogenetics (oncology), blast cell immunophenotyping and molecular genetics on blood andor bone marrow aspirate to classify type.
Classification	The WHO classification is based on the FAB classification of acute leukaemia. It incorporates morphologic, immunophenotypic, genetic and clinical features in an attempt to define entities that are biologically homogeneous and that have clinical relevance. The acute leukaemias are classified as myeloid or lymphoid based on the lineage of the blast cells. This is based on morphology of blood and bone marrow aspirate, cytochemistry, electron microscopy and cell immunophenotyping; it guides therapy and indicates prognosis.
	Acute myeloid leukemias AMLs with recurrent cytogenic abnormalities AML with t(8;21)(q22;q22), (AML1/ETO) AML with inv(16)(p13q22) or t(16;16)(p13;q22), (CBFß/MYH11) Acute promyelocytic leukemia (AML with t(15;17)(q22;q12), (PML/RAR alpha) AML with 11q23 (MLL) abnormalities AML with multilineage dysplasiaAML and myelodysplastic syndrome, therapy related AML, not otherwise categorised AML, minimally differentiated AML without maturation AML with maturation Acute promyelocytic leukemia lacking RAR alpha rearrangement Acute myelomonocytic leukemia Acute monoblastic and monocytic leukemia Acute erythoid leukemia Acute megakaryoblastic leukemia Acute basophilic leukemia Acute panmyelosis with myelofibrosis Myeloid sarcoma Acute lymphoblastic leukemias Acute lymphoblastic leukaemia may be of pre-B cell, B cell, precursor B cell, or T cell origin. Precursor B-lymphoblastic leukemia/lymphoma^a Precursor T-lymphoblastic leukemia/lymphoma^a Burkitt lymphoma/leukemia^b Acute leukemias of ambiguous lineage Biphenotypic acute leukemia Undifferentiated acute leukemia ^aListed in WHO classification under precursor B-cell and T-cell neoplasms. ^bListed in WHO classifecation under mature B-cell neoplasms. Reference: Modified from the WHO Classification of Tumours, Pathology and Genetics: Tumours of Haematopoietic and Lymphoid Tissues.
Presentation
Bone marrow failure
Anaemia
Neutropenia Fever Oral ulcers Bacterial/fungal infection	See Febrile neutropenia. Infection (increased susceptibility) Neutropenia
Thrombocytopenia Bruising Purpura
DIC Especially is acute promyelocytic leukaemia	FBC; thrombin time, fibrin degradation products, APTT, PT, fibrinogen.
Acute promyelocytic leukaemia, especially
Leukostasis (especially in acute myeloblastic leukaemia)	With extreme leucocytosis (blast cells).
Urate nephropathy, especially in acute promyelocytic leukaemia	See Renal failure - acute.