acute lymphoblastic leukemia
Introduction
Introduction to acute lymphocytic leukemia Acute lymphocytic leukemia (ALL) is a progressive malignant disease characterized by a large number of immature white blood cells similar to lymphoblasts. These cells can be found in blood, bone marrow, lymph nodes, spleen and other organs. Acute lymphocytic leukemia accounts for 80% of childhood acute leukemia, and the peak incidence is between 3 and 7 years old. ALL can also occur in adults, accounting for 20% of all adult leukemia. basic knowledge The proportion of sickness: 0.01% Susceptible people: more common in children Mode of infection: non-infectious Complications: disseminated intravascular coagulation
Cause
Cause of acute lymphocytic leukemia
Physical and chemical factors (30%):
Radiation, certain toxins, such as benzene and some chemical agents, are thought to be predisposing factors for leukemia, causing lymphocytes to become immature and differentiate and replace normal cells into the blood and tissues, inducing the disease.
Genetic factors (15%):
Chromosomal abnormalities also play a role in the development of acute leukemia. Risk factors for acute leukemia include trisomy 21, which is often associated with leukemia.
Pathogenesis
In acute leukemia, malignant cells lose their ability to mature and target (differentiate) to produce their function. These cells divide rapidly and replace normal cells. Bone marrow failure occurs when malignant cells replace normal bone marrow components. Because the number of normal cells is reduced, this patient becomes susceptible to bleeding and infection.
Prevention
Acute lymphocytic leukemia prevention
Because the cause of most cases is unclear, it is unpredictable in most cases. Minimizing exposure to factors such as toxins, radiation, and chemical agents may reduce the risk of developing the disease.
Do not touch X-rays and other harmful radiation too much. Personnel engaged in radiation work should do personal protection and strengthen preventive measures. Infants and pregnant women are more sensitive to radiation and vulnerable to injury. Women should avoid exposure to excessive radiation during pregnancy, otherwise the incidence of leukemia in the fetus is higher. However, the occasional, medical x-ray examination, the dose is small, basically does not affect the body.
Do not abuse drugs. Care should be taken when using chloramphenicol, cytotoxic anticancer drugs, immunosuppressive drugs, etc., and must be guided by a doctor. Do not use or abuse them for a long time.
A medical investigation found that chronic benzene poisoning mainly damages the human hematopoietic system, causing leukemia and platelet count reduction to induce leukemia. Benzene pollution and formaldehyde pollution in the indoor environment caused by decoration and furniture all cause harm to people's health. The use of natural stone and ceramic tiles is the main cause of radioactive cesium contamination in indoor environments. Therefore, be sure to ventilate and dry after the renovation. I bought a fan with clean air, and I also bought a large amount of activated carbon, spider plant, and green radish that can absorb harmful gases such as formaldehyde and benzene. It is best to measure with professional instruments before entering the station.
Complication
Acute lymphocytic leukemia complications Complications, disseminated intravascular coagulation
Complications of acute lymphocytic leukemia: DIC (diffuse intravascular coagulation), recurrence of acute lymphocytic leukemia, severe infection.
Symptom
Symptoms of acute lymphocytic leukemia Common symptoms Joint pain, intracranial hemorrhage, hematuria, papilledema, gingival bleeding, increased intracranial pressure, visceral hemorrhage, bloody nose, hemoptysis
Onset:
Most patients have acute onset, rapid progress, often with fever, anemia or bleeding as the first symptom, some cases have a slow onset, with progressive anemia as the main performance.
symptom:
(1) Anemia: There are anemias in the onset, but the severity varies.
(B) bleeding: Most patients have different degrees of bleeding in the course of the disease, with skin defects, ecchymosis, bleeding gums, nasal discharge is common, severe cases may have visceral bleeding, such as blood in the stool, hematuria, hemoptysis and intracranial hemorrhage .
(3) Fever: It is one of the common symptoms of acute leukemia.
Signs:
(1) Liver, spleen, and swollen lymph nodes.
(B) bone and joint performance: bone and joint pain is a common manifestation, sternal tenderness has a certain value in the diagnosis of leukemia.
(C) other signs of infiltration: male testicular involvement can be diffuse enlargement, which is one of the causes of leukemia recurrence.
Central nervous system leukemia:
Table 1 existing meninges infiltration, can affect the circulation of cerebrospinal fluid, resulting in increased intracranial pressure, patients with headache, nausea, vomiting, blurred vision, papilledema, abductor nerve paralysis and other phenomena; 2 cranial nerve palsy is mainly nerve roots Infiltration, especially through the third and seventh pairs of cranial nerves at the cranial nerve hole caused facial paralysis; 3 spinal cord is infiltrated by leukemia cells, with progressive paraplegia as the main feature; 4 vascular endothelium infiltration and leukemia cell stasis, occurs following Hemorrhagic, clinical manifestations of cerebrovascular accidents.
Examine
Examination of acute lymphocytic leukemia
Blood: Most white blood cells are 10-50×10 9 /L, and a few are <5×10 9 /L or >100×10 9 /L.
Bone marrow: Bone marrow puncture is an important method for diagnosing acute leukemia.
Cytochemistry: The primordial cells of leukemia are sometimes indistinguishable from morphological and can be identified by cytochemistry.
Biochemical tests:
Lysozyme: Determination of lysozyme facilitates the identification of leukemia types.
Uric acid.
Electrolyte and acid balance.
Chromosome examination: Chromosome examination of acute leukemia contributes to the correct typing of leukemia and estimation of prognosis.
Diagnosis
Diagnosis and differentiation of acute lymphocytic leukemia
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
When the progression of lymphoma progresses to the bone marrow and peripheral blood, it is called white blood lymphoma. At this time, its clinical and laboratory characteristics are very similar to acute lymphoblastic leukemia (ALL), which can be identified from the following points: (1) white blood lymphoma The typical clinical features of lymphoma can be manifested when the blood system is not invaded at the beginning of the disease, while the bone marrow and peripheral blood are basically normal; the anemia and thrombocytopenia of ALL are more obvious, and (2) the aggregation of tumor cells from morphologically white lymphoma Heap distribution or scattered distribution, easier to see double-nuclear or multi-nuclear lymphoma cells, larger heteromorphism, visible some normal hematopoietic cells; ALL bone marrow is less heterogeneous, often uniform leukemia cells, (3) white blood lymphocytes The prognosis of the tumor is worse than ALL.
