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Pathology
ALL is a malignant proliferation of haematopoietic precursor blast cells of lymphoid lineage
Aetiology
Unknown
Predisposing factors: ionising radiation, congenital chromosomal abnormality
Commonest leukaemia in children, median age 3.5 years, rare in adults
Philadelphia Chromosome – translocation between chromosomes 9 and 22 combining BCR and ABL to increase tyrosine kinase activity.
Signs
Hepatosplenomegaly lymphadenopathy
Symptoms
Anaemia, infection, haemorrhage, failure to thrive, bone or joint pain
Investigations
Bloods: FBC shows normochromic normocytic anaemia with increased WBC and
decreased platelets and reticulocytes
Blood Film: Lymphoblasts
Bone Marrow Aspirate: Lymphoblasts >20%
Imaging: Chest X-Ray: Assess for mediastinal mass if T-lineage ALL
Cytogenetics: Philadelphia Chromosome
Treatment
Medical: Treat infections early, blood transfusion, chemotherapy,
immunotherapy, stem cell transplantation
Prognosis
Childhood ALL >80% cure, adults poorer as higher relapse rates
Infection, bleeding, organ damage, hair loss, GI toxicity, Infertility.Key Facts
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Key Images
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Key References
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