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Original Article

Med Inn. 2017; 6(2): 10-19

Clinical and laboratory profile of acute leukemia with special reference to flow cytometry

Ratnamala Choudhury, Sreevalli A., Chaitanya H. Balakrishnan, Cecil R. Ross.


Background: Acute leukemias are a result of a sequence of somatic mutations in a multipotent primitive hematopoietic cell. It forms a major proportion of haematopoietic neoplasms that are diagnosed worldwide. Acute Myeloid Leukemia (AML) in adults accounts for 80-90% of cases of acute leukemias. Acute Lymphoid Leukemia (ALL), though common in childhood comprises 12% of all leukemias. Incidence rises again in the sixth decade but this age peak is absent in developing countries. Subtypes of AML and ALL differ in response to therapy, clinical course and prognosis. Leukemias have varied presentation. There is limited comprehensive assessment of clinical and laboratory profile of acute leukemias in Indian population. The diagnosis of leukemia only by morphological examination of peripheral blood films, is grossly inadequate. Bone marrow study and advanced diagnostic procedures like cytogenetic analysis, immunophenotyping, cytochemical staining and molecular genetics are yet to be fully incorporated in the workup of leukemias. The aim was to study the clinical and laboratory parameters of acute leukemias with special reference to flow cytometry
Methods: The study was conducted in St. John’s Medical College Hospital from October 2014 to March 2016. Consecutive patients diagnosed with acute leukemias were included in the study. Details were collected as per proforma regarding demographic factors, symptoms, signs, laboratory parameters. The morphological typing
and sub-typing of leukemia was based on peripheral smear examination, bone marrow studies (aspiration and biopsy) employing the FAB criteria, flowcytometry and cytogenetics.
Results: In our study of 100 patients with acute leukemia, 70 had AML, 27 had ALL and 3 remained as unclassified acute leukemia. Male preponderance is seen in the patients studied, with 55% males and 45% females with male:female ratio of 1.2:1. Fever is the most common symptom. Pallor is the most common sign. Anemia is the
most common haematological abnormality 98% (n=98) followed by thrombocytopenia in 93% (n=93). More than 30% blasts in peripheral smear is seen more commonly in ALL than AML. Coagulopathy, DCT positivity, spontaneous tumor lysis syndrome, deranged renal and liver parameters are more common in ALL than AML. Though 22% remained unclassified by peripheral smear, 13% could be classified by bone marrow study and 6% by flow cytometry. Thus only 3% remained unclassified after bone marrow and flow cytometry analysis of the same.
Conclusion: Diagnosis of leukemia is not only by morphological examination of peripheral blood films alone, but also requires bone marrow study, advanced diagnostic procedures like flow cytometry and cytogenetic analysis.

Key words: Acute myeloid leukemia, acute lymphoid leukemia, flow cytometry

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