Leukemia

Leukemia is a tumor from the blood-forming cells that affects the bone marrow with the displacement of normal hematopoietic germs, as well as other organs and tissues.

Acute leukemias are characterized by an increase in the number of blast, or leukemic, "young" cells in the bone marrow, spleen, lymph nodes, liver and other organs and tissues. Depending on the morphological and cytochemical features of blast cells, several forms of acute leukemia are distinguished: myeloblastic, lymphoblastic, plasmablastic, erythromyelosis, etc. Acute lymphocytic leukemia is the most common malignant tumor disease in children, less common in adults; Acute myelogenous leukemia is the predominant form of leukemia in adults.

The disease often begins with general weakness and blurred pain in the bones, headache, nausea, irritability. During the unfolded clinical picture, severe weakness, severe pain in the bones, fever are noted . Without apparent cause, small and extensive hemorrhage in the skin and mucous membranes, bleeding gums, nasal, uterine, intestinal bleeding are noted. Often develop ulcerative and necrotic and fungal lesions of the skin and mucous membranes, especially the oral cavity, throat and gastrointestinal tract. On the skin of the face, the scalp may appear large nodes, isolated or merged into conglomerates. On the skin of the trunk, specific nodular eruptions may occur, merging with each other into plaques or forming diffuse foci of partial erythroderma. In a number of cases, as a result of the destruction of a specific infiltrate, ulcerative necrotic foci appear in the skin. Lymph nodes, spleen and liver can be enlarged, more often moderately. Body temperature is high with large swings, but can be subfebrile. In the blood blast cells are present, the number of platelets and erythrocytes is often reduced; In the bone marrow there is a high content of blast cells.

The diagnosis is made on the basis of the clinical picture (the shape of acute leukemia is determined by the morphological and cytochemical parameters of blast cells).

Patients are hospitalized. Treatment is performed with cytostatic agents, with lymphoblastic acute leukemia - in combination with corticosteroids; For the correction of anemia, a transfusion of erythrocyte and platelet (with bleeding) mass is prescribed. The course of acute leukemia is progressive. However, modern methods of treatment can achieve remission.

Chronic leukemia. These include chronic myelogenous leukemia and lymphocytic leukemia, myeloma, chronic subleukemic myelosis, polycythemia, which is characterized by erythrocytosis (an increase in the number of erythrocytes), and others.

Chronic myelogenous leukemia is asymptomatic for a long time and can be diagnosed with random blood testing (moderate increase in the number of mature leukocytes, promyelocytes and myelocytes are found - intermediate forms of the myeloid series). In the period of severe clinical picture, weakness, bone pain, sweating, decreased appetite, weight loss, low-grade fever, a feeling of heaviness in the abdomen and pain in the spleen due to inflammation of her capsule or as a result of heart attacks; As a rule, the liver and spleen are enlarged. Sharply decreases the body's resistance to all types of infection. In this regard, there are pneumonia, fungal and purulent lesions, which can lead to death. In the blood gradually increases the number of leukocytes, mainly promyelocytes and myelocytes, increases the content of eosinophils and basophils. In the terminal stage of the disease, the spleen and liver are significantly enlarged, lymph nodes are enlarged in some patients, symptoms of cardiovascular insufficiency (dyspnea, tachycardia , hypotension, etc.) may develop.Cahexia may develop.In the blood blast cells (imperious crisis), decreases The number of erythrocytes, the content of hemoglobin decreases, the number of platelets decreases sharply, and the number of blast cells increases in the punctate of the bone marrow and the number of cells in the red row decreases.

The diagnosis is made on the basis of the clinical picture, a general blood test and a bone marrow examination. Treatment is carried out in a hospital or outpatient. Apply cytostatic agents; With indications - radiation therapy, splenectomy.

Chronic lymphocytic leukemia is characterized by proliferation of lymphoid tissue replacing normal bone marrow hematopoiesis; With a significant increase in the number of lymphocytes in the blood. The disease develops gradually. There is a moderate increase in lymph nodes (with palpation they are not very dense, mobile, painless), spleen and liver. In the blood, as a rule, an increase in the total number of leukocytes and lymphocytes is found. Gradually the disease progresses: weakness, sweating, often increase body temperature, significantly increase lymph nodes and spleen. Enlargement of the mediastinal lymph nodes can lead to compression of the trachea and large vessels, which causes severe coughing in the patients, dyspnea with exercise, cyanosis of the face, hands, neck. As a result of progressive thrombocytopenia, bleeding events can develop. During this period, the number of red blood cells decreases, the hemoglobin content decreases (hemolytic anemia may occur), the number of leukocytes increases. A similar picture is in the punctate of the bone marrow. The terminal stage of the disease is characterized by exhaustion, fever, repeated pneumonia and other bacterial, viral and fungal infections (including pustular and fungal lesions of the skin and mucous membranes). The diagnosis is made on the basis of a clinical picture (enlarged lymph nodes) and an increase in the number of lymphocytes in the blood and bone marrow.

Treatment with slow progression of the process includes a full-fledged diet and the appointment of vitamins. When the clinical picture is expanded, the treatment is performed in a hospital. Chemotherapy is indicated, with local increase in lymph nodes-radiotherapy. According to the testimony, for example, when autoimmune hemolytic anemia is attached to thrombocytopenia, corticosteroid hormones are prescribed. When developing infectious and viral complications, antibiotics are recommended. In case of a benign disease, patients can maintain their ability to work up to 10 years or more; They (as well as patients with acute leukemia) should be under constant follow-up care.