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Leukaemia

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Abstract

Leukaemia is a malignant transformation of cells of the haemopoietic system and is characterized by an abnormal proliferation of blood cells, usually white blood cells. Leukaemia is a broad term covering a spectrum of diseases that includes acute leukaemia, chronic leukaemia and the leukaemic phase of lymphoma. Although Leukaemia is not a common condition, it is important because of the diagnostic challenges in distinguishing the different types, which have varying treatment outcomes and prognoses. This chapter considers the haemopoietic system – leucocyte lineages; aetiology; acute leukaemia; chronic leukaemia; myelodysplastic syndrome; general approach to the leukaemic patient; management of leukaemia. An 11-year-old female Golden Retriever weighing 32.0 kg; A 9.5-year-old neutered Boxer weighing 30.2 kg.

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Figures

Image of 16.1
16.1 Schematic diagram depicting haemopoiesis in the bone marrow. The different cell lineages recognized in peripheral blood are the progeny of pluripotential stem cells.
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16.2 Schematic diagram of the normal maturation process of bone marrow showing the pyramidal arrangement, with the dividing cells at the apex and non-dividing mature cells at the base.
Image of 16.3
16.3 Schematic diagram of bone marrow depicting the difference between acute and chronic leukaemia in the level of transformation and outcome. In acute leukaemia, transformation of early precursors results in a massive proliferation of undifferentiated cells. In chronic leukaemia, transformation at a later stage results in an overproduction of mature differentiated cells.
Image of 16.5
16.5 Cellular morphology in acute and chronic leukaemia. Two lymphoblasts in a case of B cell acute lymphoblastic leukaemia (ALL). The blasts are 2.5 times the diameter of red blood cells (RBCs), have round nuclei containing stippled chromatin and an indistinct nucleolus. Cytoplasm is sparse. Bone marrow from a dog with B cell ALL. There are numerous lymphoblasts with round nuclei, stippled chromatin and sparse basophilic cytoplasm, sometimes containing vacuoles. There are a few plasma cells. Haemopoietic precursors are not present because the marrow has been ablated by leukaemic cells. Blast cell from a dog with acute myeloid leukaemia (AML-M1). The myeloblast is three times the diameter of an RBC, with a round nucleus containing stippled chromatin and sparse cytoplasm. It is very similar to the lymphoblasts shown in (a), illustrating the need for immunophenotyping. Bone marrow from a dog with acute monoblastic leukaemia (AML-M5a). These blast cells often have irregular indented nuclei, sometimes containing nucleoli. They have more abundant basophilic cytoplasm with the nucleus positioned eccentrically in the cell. The cytoplasm sometimes contains small clear vacuoles and occasionally contains pink granules. Blast cell in blood from a dog with acute monoblastic leukaemia (AML-M5a). This blast cell has a round nucleus with sparse cytoplasm, which contains prominent pink cytoplasmic granules. Such granules may be seen in both lymphoid and myeloid leukaemia. Bone marrow from a cat with erythroleukaemia (AML-M6). There are many large rubriblasts with a large nucleus containing quite coarse chromatin and a prominent large nucleolus. The blasts have abundant basophilic cytoplasm. There are also some developing RBC precursors. (Courtesy of Robin Allison, Oklahoma State University) Bone marrow from a dog with acute megakaryoblastic leukaemia (AML-M7). There are some mononuclear blast cells and in the centre a trinucleated blast cell with prominent blebs of cytoplasm protruding from the cell surface. Small lymphocytes from a dog with chronic lymphoblastic leukaemia (CLL). The cells are slightly smaller than neutrophils, have round nuclei with clumped chromatin (tortoise-shell pattern) and no nucleoli. Large granular lymphocytes in a case of T cell LGL CLL. These cells have mildly enlarged nuclei containing mature clumped chromatin and have abundant light staining cytoplasm with several pink granules positioned on one side of the nucleus. Leukaemic phase of high-grade lymphoma. These large lymphoid cells are difficult to distinguish from the cells in ALL. (All smears stained with Modified Wright’s stain.)
Image of 16.10
16.10 Flow cytometric analysis of cells from a dog with T cell acute lymphoblastic leukaemia. The dot plot on the left shows a single population of cells with low complexity (granularity) and moderate size. The histogram plots on the right show labelling with two antibodies (CD3e and CD34) in black, overlaid with the low fluorescence of the negative control in red.
Image of Bone marrow aspirate showing lymphoblast, plasma cells and small lymphocytes. (Modified Wright’s stain; original magnification x1000)
Bone marrow aspirate showing lymphoblast, plasma cells and small lymphocytes. (Modified Wright’s stain; original magnification x1000) Bone marrow aspirate showing lymphoblast, plasma cells and small lymphocytes. (Modified Wright’s stain; original magnification x1000)
Image of Blood smear showing small lymphocytes with a round nucleus containing condensed chromatin, no nucleoli and sparse cytoplasm. (Modified Wright’s stain; original magnification x1000)
Blood smear showing small lymphocytes with a round nucleus containing condensed chromatin, no nucleoli and sparse cytoplasm. (Modified Wright’s stain; original magnification x1000) Blood smear showing small lymphocytes with a round nucleus containing condensed chromatin, no nucleoli and sparse cytoplasm. (Modified Wright’s stain; original magnification x1000)

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