Issue of September 16, 2018
Mt. Province

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All about leukemia

September is designated as blood diseases month. Today’s article is written by Dr. Kimberley Mendoza Cutiyog-Ubando, a specialist in adult medicine with subspecialty in hematology, the field that deals with the diagnosis and treatment of blood diseases. She is a fellow of the Philippine College of Physicians and a Diplomate of the Philippine Society of Hemato-logy and Blood Transfusion. She earned her degree in Medicine at Saint Louis University, had her training in Internal Medicine at Baguio General Hospital and Medical Center, and her fellowship training in Hematology at the Philippine General Hospital. She practices in Baguio City and La Trinidad, Benguet and is affiliated in most hospitals.

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The normal composition of the blood has been discussed in last Sunday’s issue. Blood diseases come from any deviation from the normal production of one or more of the blood’s components – red blood cells (RBCs), white blood cells (WBCs), platelets (plasma). Aside from the clinical profile, a complete blood count (CBC) is vital in the initial assessment of a person suspected to have a hematologic disease. The next step is to review via a microscope the blood extracted to better characterize the blood cells. This is referred to as the peripheral blood smear.

White blood cell disorders such as leukemia are a group of malignancies from one or more of the types of WBCs, such as and more commonly, the neutrophils, lymphocytes, and monocytes. In general, they present with more than normal WBC count. Some leukemias have normal or low WBC count. The classification of leukemia is based on the duration of symptoms and type of WBC affected. Depending on the onset of symptoms, leukemia can be acute (days to weeks) or chronic (months to years). Also, the number of immature white blood cells in the blood and bone marrow (>20 percent immature cells or blasts) is an important parameter to classify acute leukemia. The bone marrow is the site of blood cell production. It is semi-solid and found inside the hollow portion of bones. That is why a bone marrow examination is part of the work-up in classifying leukemia.

The more common chronic leukemia are chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL). Chronic leukemia usually present with spleen enlargement and increase in the white cell count. They have better prognosis than acute leukemia. Acute leukemia do not usually present with spleen enlargement. Acute leukemia can be derived from myeloid cells – acute myeloid leukemia (AML) or lymphoid cells – acute lymphoid leukemia (ALL). AML are more commonly seen in adults and elders while ALL are more commonly seen in children and young adults.

Special tests known as flow cytometry, FISH (fluorescence in situ hybridization), molecular and cytogenetics are also important in the overall assessment of leukemia.

There is no specific symptom pointing to leukemia. Fever is a common early manifestation. Fatigue is also a usual complaint especially if accompanied by a decrease in the hemoglobin (oxygen carrier in the red blood cells), ordinarily known as anemia. Moderate to severe anemia may also present with paleness, weakness, tinnitus (ringing in the ear) and palpitation (noticeable heartbeat). When leukemia is accompanied by a drop in platelet count, signs of bleeding can occur. They can present as bruises or bleeding anywhere in the body such as nose or gum bleeding or bleeding in the stool. Weight loss, although may be present, is not a prominent symptom of persons with leukemia.

Causes of leukemia are due to several environmental factors (such as smoking and high dose radiation exposure in AML) and mutations within the bone marrow stem cells, or simply, the “mother cells.” Leukemia are usually acquired, hence, are not hereditary or passed on in families, however, there are cases where hematologic diseases cluster in a family unit.

Treatment for leukemia will depend on the type and severity of the leukemia, age of the patient, performance status of the patient, and the result of the special tests, which will also help in the prognosis of the patient. Options for treatment will involve repeated rounds of chemotherapy and hematopoietic stem cell transplantation (Bone marrow transplantation). Blood transfusion is also a part of the management for leukemia. Management of leukemia is multidisciplinary due to its complexity.

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