Leukemia

Introduction to leukemia Leukemia, also known as blood cancer, is a malignant proliferative lesion of hematopoietic stem cells and a clonal malignant disease of hematopoietic stem cells. Leukemia cells in their clones lose their ability to further differentiate and mature and arrest at different stages of cell development. In bone marrow and other hematopoietic tissues, leukemia cells accumulate and accumulate in other organs and tissues, and at the same time inhibit normal hematopoiesis. The clinical manifestations are anemia, hemorrhage, infection and infiltration of various organs. Leukemia is treatable. Commonly used quality methods are chemotherapy, radiotherapy, hormone therapy, and bone marrow transplantation. The cure rate is related to age, and children are more likely to be cured than adults. basic knowledge The proportion of sickness: 0.00005% Susceptible people: no specific population Mode of infection: non-infectious Complications: sepsis

Cause of leukemia

Virus (30%):

It has long been demonstrated that C-type RNA tumor viruses or retroviruses are the cause of spontaneous leukemia in mammals such as mice, cats, cows, sheep and primates, which can be sequenced by endogenous reverse transcriptase in RNA sequence. A replica of synthetic DNA, a provirus, can induce malignant transformation when inserted into the chromosomal DNA of the host.

The tumor virus carries the virus-derived tumor gene (v-onc). Most vertebrate (including human cells) genes have a gene called a tumor-derived gene that is homologous to v-onc, and the gene that v-onc is integrated into the host cell. In vivo, the adjacent gene can be malignant, and the infection of the retrovirus can also cause the activation of the tumor-bearing gene, which becomes a malignant transformation gene, leading to malignant transformation of the target cell. Even if the virus gene enters the body does not contain v-onc, if the gene is changed The normal function may also cause leukemia.

The etiology of human leukemia has been studied for decades, but so far only adult T-cell leukemia has been caused by viruses.

Genetic factors (40%):

Genetic factors are associated with the onset of certain leukemias. 8.1% of leukemia patients have a family history of leukemia, while the control group is only 0.5%. The incidence of acute lymphoblastic leukemia in close relatives is 30 times higher than expected. Some chromosomes are distorted and broken. Hereditary disorders are often associated with a higher incidence of leukemia, such as Down syndrome, congenital vasodilatation erythema (Bloom syndrome) and Fanconi anemia.

50% of children with acute lymphoblastic leukemia have a special palm print called the Sydney line. There is a connection between leukemia and HLA antigen type. For example, acute lymphoblastic leukemia is often accompanied by HLA-A2 and A9, all of which indicate genetic factors and leukemia. There is a connection between the onset of the disease, but for most leukemias, leukemia is not a hereditary disease.

Radiation factor (10%):

Ionizing radiation has a leukemia-like effect, and its effect is related to the size of the radiation dose and the radiation site. A large dose (1 ~ 9Gy) or multiple small doses have leukemia effect.

Larger exposure of the whole body and the radiation field, especially the bone marrow, can cause the bone marrow to be so immunized that the chromosomes can be observed to break and recombine for several months after irradiation. The radiation can cause reversible rupture of the double-stranded DNA, thereby making the cells Internal tumorivirus replication and excretion, radiation can induce acute, chronic non-lymphocytic leukemia and chronic myeloid leukemia, but no chronic lymphocytic leukemia, and there is often a period of myelosuppression before the onset, the incubation period is about 2 to 16 years .

Chemical factors (5%):

The leukemia-induced effect of benzene is relatively positive. Benzene-induced acute leukemia is mainly caused by acute myeloid leukemia and erythroleukemia. Alkylation agents and cytotoxic drugs can also cause secondary leukemia. Most secondary leukemias occur in the original lymphocytes. Systemic malignancies and malignant tumors that are prone to immunodeficiency occur after long-term alkylating agents, and secondary leukemia is also likely to occur after chemotherapy for breast, ovarian, and lung cancers.

Leukemia prevention

(1) Avoid contact with excessive X-rays and other harmful radiation. Personal protection should be provided to those engaged in radiation work. Pregnant women and infants should pay special attention to avoid contact with radiation.

(2) Prevention and treatment of various infections, especially viral infections, such as type C RNA viruses.

(3) Careful use of certain drugs, such as chloramphenicol, phenylbutazone, certain antiviral drugs, certain anti-tumor drugs and immunosuppressants, should avoid long-term use or abuse.

(4) Avoid contact with certain carcinogens and do occupational protection and monitoring, such as in the production of phenol, chlorobenzene, nitrobenzene, spices, pharmaceuticals, pesticides, synthetic fibers, synthetic rubber, plastics, dyes, etc. Take care to avoid harmful and toxic substances.

(5) For high-risk groups of leukemia, regular census work should be done, paying special attention to leukemia police numbers and early symptoms. Those who have conditions can take Tianxian vital energy source for preventive treatment.

Leukemia complications Complications sepsis

(1) Infection: due to leukemia caused by normal leukopenia, especially neutropenia, and chemotherapy and other factors also lead to the lack of granulocytes, making patients prone to serious infection or sepsis, bacteria that often cause infection: Gram Positive bacteria, such as Staphylococcus aureus, hemolytic streptococcus, coryneform bacteria and other Gram-negative bacilli, such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella, etc., mold infection with Candida albicans, Aspergillus, Mucor For the above-mentioned fungal infections, the above-mentioned fungal infections occur mostly in patients with long-term neutropenia or persistent fever and antibiotics are not sensitive. Some patients receiving corticosteroid treatment are more susceptible to viral infection due to low cellular immune function, such as varicella. Herpes simplex virus, herpes simplex virus, etc., in addition to Pneumocystis carinii infection, upper respiratory tract infection and pneumonia is a common type.

(2) Intestinal failure: due to the treatment of chemotherapy drugs in leukemia, radiotherapy means affecting gastrointestinal function, leading to fear of gastric failure, nutritional supplementation of patients has become a prominent problem, currently using subclavian vein cannulation into the superior vena cava High-nutrient infusion only solves some problems, and nutritional deficiency can cause complications such as pneumonia and enteritis.

(3) high uric acid blood test: normal people due to nucleic acid metabolism decomposition, daily urinary excretion of uric acid 300 ~ 500mg, leukemia patients due to a large number of leukemia cell nucleic acid decomposition can increase uric acid output by dozens of times, when patients receive chemotherapy, radiotherapy, etc. Hyperuricemia occurs when treated, and corticosteroids can increase hyperuricemia. High concentrations of uric acid quickly over-saturate and precipitate, causing extensive damage to kidneys and uric acid stones, which can lead to oliguria and no urine. Patients with leukemia must be supplemented with adequate fluids to ensure a certain amount of urine, and take allopurinol. If renal failure occurs, the amount of fluid should be limited and dialysis treatment.

(4) Bleeding: Leukemia patients with malignant hyperplasia of leukemia cells, platelets are significantly reduced, easy to cause respiratory, digestive tract, urinary bleeding, especially intracranial hemorrhage, so it is necessary to take active hemostasis according to the cause, including infusion of concentrated platelets.

(5) Pulmonary diseases: due to the normal mature neutrophils in leukemia patients, immune function is reduced, often leading to lung infection, in addition, leukemia cells, infiltration can block small blood vessels in the lungs, bronchial dyspnea, respiratory distress syndrome The chest radiograph may have a ground glass or a miliary mesh, which can be used for experimental treatment of lung radiation.

(6) Electrolyte imbalance: In the course of treatment of white backlog disease, potassium is often destroyed due to excessive destruction of leukemia cells or due to chemotherapy-induced renal damage, and the diet is poor due to chemotherapy, and the digestive system is dysfunctional. Caused by hypokalemia, or increased release of phosphorus due to destruction of leukemia cells, resulting in low calcium, etc., so pay attention to the electrolyte concentration of potassium, calcium, sodium, etc. during the treatment.

(7) disseminated intravascular coagulation (DIC): disseminated blood vessels are a group of severe hemorrhagic syndromes.

Symptoms of leukemia Common symptoms Abnormal outer side of eyebrows sparse and dry necrosis of fine ear shells Liver splenomegaly, shortness of breath, punctate hemorrhage, severe pain, coma, persistent fever, bone pain, white hair

1. Symptoms caused by destruction of bone marrow hematopoietic function

(1) It is prone to bruising and spotting: the megakaryocytes resulting from the production of platelets are reduced, resulting in a lack of platelets.

(2) Anemia: The reduction of the mother cells that make red blood cells, resulting in the lack of red blood cells, easy to walk, or exercise, panting and dizziness.

(3) persistent fever, long-lasting infection: most white blood cells are blood cancer cells, without normal function, resulting in decreased immunity and vulnerability to infection.

2. Symptoms caused by perforation of blood cancer cells

(1) swollen lymph nodes.

(2) bone pain or joint pain: blood cancer cells caused by a large number of hyperplasia in the bone marrow, tapping the sternum of patients with acute lymphocytic leukemia, often cause severe pain.

(3) The gums are swollen.

(4) Hepatosplenomegaly.

(5) Headache and vomiting: The performance of blood cancer cells penetrating into the central nervous system.

(6) The skin appears lumpy: because it looks slightly green, also known as green tumor.

(7) Pericardial membrane or pleural effusion.

3, the special performance of various types of leukemia

(1) Acute promyelocytic leukemia: diffuse bleeding.

(2) Chronic myelogenous leukemia: In most patients, the number of platelets rises and the spleen enlarges.

(3) Chronic lymphocytic leukemia: rarely occurs in Chinese people, the age of predilection is mainly after middle age, especially the elderly.

Leukemia examination

When the blood and bone marrow are not sufficient to confirm acute leukemia, the lymph node puncture smear and the specific lesion print can be used to find the corresponding leukemia fine-binding pathological print, which is helpful for diagnosis.

Blood biochemical examination:

1 terminal deoxynucleotidyl transferase (TDT): increased activity at ALL and no activity at ANLL.

2 alkaline phosphatase (AKP): apparently at ALL, AML was significantly reduced.

Leukemia diagnosis

diagnosis

Leukemia is a disease of the bone marrow. Therefore, bone marrow puncture and bone marrow biopsy are required to confirm the diagnosis. In order to further confirm the type of leukemia, additional special examinations are needed to accurately classify leukemia and give the most appropriate treatment.

These special tests include: cell biochemical special staining, flow cytometry, and chromosome examination.

Differential diagnosis

It should be differentiated from aplastic anemia, myelodysplastic syndrome, infectious mononucleosis, primary thrombocytopenic purpura and leukemia-like reactions.

1. Aplastic anemia.

2. Myelodysplastic syndrome.

3. Infectious mononucleosis.

4. Primary thrombocytopenic purpura.

5. Leukemia-like reactions.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.