Acute leukemia

Retikulez divided into: 1) diffuse and 2) characterized tumor growths.
The first characteristic of the absence of pronounced hyperplasia of the lymph nodes and spleen. For this variant of leukemia main clinical sign is progressive anemia, similar to aplastic (gipoplasticheskaya). One of the peculiar transitional forms of reticulata-genocidalists should be considered erythromelas (leukaemia, according to the old terminology), characterized by the tendency to partial differentiation genocidalists in items eritropoeticescoe series with a strong anaplasia last (see Erythromelas). With tumorous growths occur retikulez, chlamydia (see) and gigantopithicus lymphoma (see Lymphoma gigantopithicus). This group is paraproteinemias retikulez: myeloma (see) and macroglobulinemia valdenstroma.
Forms of leukemia-related reticulatum (see), most often occur on the type and leukemia or subleikemical options (leikemicakie, leykopenicheskih and subleikemical HP), under which the proliferation of undifferentiated elements in the bone marrow associated with the violation of their vyplavina to the periphery, and the blood picture is characterized by low, normal or slightly increased the total number of cells and the percentage of immature cells. Diagnosis in these cases is determined on the basis of the study of bone marrow punctate, which show a large number of myelokaryocytes (there is a dissociation between the picture myelogram and hemogramme). According to I. Century Davydov, the cells retikuliarna of syncytium in the bone marrow prevent vyplyvaya in the blood not only undifferentiated, but Mature cells of hemopoiesis.
Genocidalists acute (subacute) is characterized by impaired blood level undifferentiated elements of hemopoiesis - reticular cells and genocidalists. Termination of differentiation and proliferation with anaplasia these elements determine the development of clinical and morphological symptoms of acute leukemia (printing. table, Fig. 1).
First, often violent manifestations of genocidalists probably predates more or less long period rather quiet, gradually increasing in its severity course, when patients feel only some weakness, blurred pain in the bones, etc., Then, usually in the period of almost complete replacement of the normal blood-forming tissue leukemic infiltrates, develops the typical clinical picture of acute leukemia. This picture is of the symptoms that reflect hyperplasia of organs and tissues, in which the proliferation of leukemic elements, bleeding (result thrombocytopenia and violation of the permeability of the vascular wall, and some violations in the coagulation of blood), anemia, General intoxication and related L. nonspecific allergic manifestations.
Patients complain of weakness, bone pain, fever, the emergence of "unmotivated bruises and petechiae on the skin, periodic gingival and nasal bleeding. When viewed often find a modest increase in peripheral lymph nodes, liver and spleen. Very often there giperplazia gums, which papillae down to the teeth, sometimes covering them almost completely (Fig. 2).

punctat bone marrow of the patient geocitiescom
Fig. 1. Punctat bone marrow of the patient genocidalists. Fig. 2. Punctat bone marrow of the patient genocidalists. Atypical genocidally with coarse grain in the cytoplasm.

Bleeding is manifested in various forms: from petechial rash on the skin and mucous membranes to the massive gastrointestinal bleeding and haemorrhage in different sections of the brain and spinal cord that can serve as the direct cause of death. Bleeding in combination with anemia and severe leukemia intoxication determine the development of myocardial degeneration violation of General circulation.

Fig. 2. Acute genocidalists: hyperplasia of the mucous membrane of the gums with ulcero-necrotic foci.

Emergency disposition of these patients to the so-called small infections and sharp decrease of immunity lead to the development of ulcerative necrotic symptoms, fungal infections (candidiasis) on skin and mucous membranes, especially in the oral cavity, pharynx, esophagus, rear passage and genital organs, and in the course of the intestines. This, apparently, is also promoted by the local leukemic infiltration and widely used nowadays corticosteroid therapy.
Blood picture usually reflects the processes of leukemic transformation kostnomozgovy blood: the number of nuclear items increased to leukemia digits (up to 50 000-100 000 and more than 1 mm3), and the majority of them are represented by emotionlessly. In punctate bone marrow genocidally also make up the majority of cell forms. Quite often the number of nuclear form in peripheral blood is reduced. One of the basic properties of leukemic cells was dedifferentiate and anaplasia. Morphologically first of all it is expressed in the emergence of the ugliest forms of genocidalists that do not occur in normal blood-forming tissue. You can often notice smoothness leptogrammica nuclear structure, bad severity nucleon, the emergence of Taurus Auer, excessive trustcharlotte and vacuolization of cytoplasm, pale-blue tone of cytoplasm inherent reticular cells, irregular shape of the nucleus, which often looks like a twisted, bouhoubeyni impressions. Among these genocidalists decided to allocate the external characteristics of genocidally lymphoid, monocytogenes and myeloid types.
Recently began to single out the so-called promyelocytic forms of acute leukemia. This term, however, it is impossible to recognize unconditionally. Correct to assume that in these cases has also genocidalists, however, because some of metabolic disturbances in the cells (exchange anaplasia) last become outwardly similar to promyelocyte because of the emergence of coarse grit in the cytoplasm. These grain - dark-cherry colour, sometimes fill all the cytoplasm and even close the kernel (printing. table, Fig. 2)completely tusevima its structure. There is an assumption that they contain geparinoidam or fibrinoliticescoe matter, because these forms of acute leukemia characterized by very violent manifestations of bleeding.

When Charlecote bone marrow, lymph nodes and tumor growth (if any) in the context of becoming a kind of green, depending on the presence of pigment protoporphyrin. In light of this color change, and the surface of the cut becomes grayish. If the tumor grows in acute leukemia have on the cut green color, then talk about chloroma. During the life of such a diagnosis is rare, but when Charlecote more often than in other forms of acute L.; in the blood and bone marrow are detected genocidally grit and vacuolation in the cytoplasm.
Bone marrow biopsy (see marrow puncture) is of great diagnostic value in case if in the peripheral blood of the number of genocidalists small. Often in smears punctate bone marrow along with hemocytometer found reticular cells, located in the form of syncytium. Anemia detected during investigation of peripheral blood, corresponds to the sharp narrowing of the red Rostock in the bone marrow; thrombocytopenia - megakaryocytopoiesis. Becomes more valuable sternal puncture in control of the treatment, when the remission judged not on the normalization of hemogramme, and the disappearance genocidalists infiltration and to restore normal blood in the bone marrow.
For acute leukemia usually rapidly progressive. Lately due to the success of chemo - and hormonotherapy increasingly observed remission, especially in children. However, remission usually are temporary (with the exception of certain cases), last for several months. Death occurs when the effects of total resistance to all the methods of treatment, rapidly growing anemia, hemorrhage, symptoms of intoxication and ulcero-necrotic complications.
Treatment of a patient with acute leukemia must be started immediately after the establishment of the diagnosis. The leading place in therapy of genocidalists is a 6-mercaptopurine (6-MP). Its action is based on the ability to influence intimate mechanism of intracellular metabolism, causing the death of young proliferating cells. The drug is used inside a rate of 2.5 - 3 mg per 1 kg of the patient's weight per day in accordance with the degree genocidalists metaplasia of bone marrow and regardless of the number of leukocytes, and platelets in the blood. Therapeutic effect is usually detected within 2-4 weeks; in case when it appropriate dose of 6-MP be increased to 4 mg/kg / day.
Simultaneously with 6-MP appoint one of corticosteroids, most often prednisolone in a daily dose of 1 to 1.5 mg per 1 kg of the patient's weight in 3-4 reception. Treatment with prednisolone continue until clinical and at least partial hematological compensation process. Then dose of prednisolone is gradually reduced to 40 to 30 mg a day before the onset of clinical and hematological remission; hormonal therapy can be discontinued by reducing the dosage to 2.5-5 mg every 2 days until the next exacerbation. Treatment 6-MP should be continued in the form of maintenance doses (50-100 mg / day) and in the period of remission, temporarily stopping it only in times of normalization kostnomozgovy blood.
In developing resistance to the specified treatment, as well as some special form of the flow of genocidalists methotrexate applied 5-7,5 mg / day, cyclophosphamide (Endoxan) 150-200 mg / day. In extremely rare cases, if the flow of genocidalists accompanied by the development of local tumor growths with symptoms compression vital organs, used x-ray treatments in small doses (50-100 R a day) to the lesion.
During the whole period of treatment shows usage of calcium drugs, ascorbic acid, rutin, when anemia is a blood transfusion in the development of acute inflammatory processes of antibiotics.
The division of acute forms of leukemia - genocidalists - morphological features of genocidalists has some practical value in the choice of means of treatment. It is noticed, that at "lymphoid"less when "monocities" the most effective variants of corticosteroid hormones, when myeloblastic - 6-MP. The so-called promyelocytic options genocidalists are resistant to all therapies, rapid current and death with extensive hemorrhages.