Leukemia:

When there is an abnormal amount of increase of white blood cells (WBC); in the body it is termed as leukemia. It is dysfunctional proliferation of the developing WBC.

Leukemia is classified in 4 categories as under:

Classification
Acute	Chronic	Myeloid	Lymphoid
Abnormal cells are present which are less mature.	Cells are mature	Includes: Monocytes, Macrophages, Neutrophils, Basophils, Eosinophils, Erythrocytes, Megakaryocytes	Includes: T-cells B-cells Natural killer cells
Developments of these cells are fast.	Development of cells are slow.
These are known as ‘Blast Cells’.
Symptoms are rapidly progressed.	Gradually symptoms are progressed
Cells are not functional.	Cells are functional.

It is further divided into 4 types:

Types
Acute Lymphoblastic Leukemia (ALL)	Acute Myelogenous Leukemia (AML)	Chronic Lymphocytic Leukemia (CLL)	Chronic Myelogenous Leukemia (CML)
Common in pediatrics (80%).	Common in teenagers and also in adults.	Common in 60 to 70 years of age.	Common in 25 to 60 years of age.
20% in adults.		Mature abnormal WBC of lymphoid origin hyperplasia.	It has no noticeable symptoms and is diagnosed in routine blood tests.

Etiology:

- Ionizing radiation exposure: X-ray technicians are at higher risk of developing leukemia.

- Benzene exposure: Benzene is found in gasoline; which is used in chemical factory. Occupational cause can also lead to leukemia.

- History of chemotherapy: Patient who have undergone chemotherapy previously, for any cancer or for the same; are at higher risk of developing leukemia.

- History of leukemia: Recurrence of the disease is common, if patient have the history of leukemia.

- Viral infection (Epstein Barr virus, Human T-cell Leukemia)

- Genetic syndrome: Certain genetic disorder, such as Down's syndrome, increases the risk of the condition.

- Family history: If 1st relative have leukemia, then the chances of developing the same condition increases.

Sings and Symptoms:

Acute leukemia:

Common symptoms includes;

- Fever or chills

- Persistent unexplained weight loss

- Lethargy and generalized weakness

- Easy bleeding or bruise

- Shortness of breath

- Heavy menstrual cycle

- Bone pain and tenderness

- Swollen lymph nodes

- Swollen liver and spleen, which leads to abdominal pain

- Recurrent infection

Chronic leukemia is mostly asymptomatic.

Work up:

- Complete blood count

- Complete metabolic panel

- Liver function test

- Coagulation profile

- Peripheral blood smear

- Bone marrow biopsy

Differential Diagnosis:

- B12 and folate deficiencies

- Copper deficiency

- Viral infection

- Drugs

- Autoimmune disease

Treatment and Management:

- Chemotherapy: Administration of drugs which breakdown the cells very rapidly. Combination of drugs is usually administrated in sessions. However, side effects of this therapy includes; hair loss, nausea, vomiting, loss of appetite and high risk of frequent infection due to destruction of white cells.

- In CML: Imatinib (Tyrosine kinase inhibitor)

- Radiotherapy: Radiations are given to targeted cancer cells. It is recommended in cases of distant spread of the cells. Side effects depends on the part

- Monoclonal antibodies

- Stem cell transplantation

Complications:

- Tumor lysis syndrome: Chemotherapy causes breakdown of tumors, which results into release of several contents into bloodstream.

- Disseminated Intravascular Coagulation

- Infection

Prognosis:

It depends upon the type and time of detection of the disease.