A Clinical, Hematological and Immunophenotypic Analysis of Acute Leukemias in Adults in a Tertiary Care Center in North India: A Cross-Sectional Study

Anil Kumar

Abstract


Abstract

Introduction: Accurate diagnosis and classification of acute leukemias has helped in identifying and dividing acute leukemias (ALL, AML) into low-risk, intermediate-risk and high-risk groups.

Objectives: this study was conducted to determine the clinical profile, hematological profile, immunophenotypic characteristics of acute leukemias in adults, to study correlation between morphological and immunophenotypic characteristics of acute leukemias in adults presenting to a tertiary care center.

Material and Methods: 50 subjects who fulfilled the inclusion criteria were enrolled for this cross –sectional study from September 2009 to December 2011.the patients underwent clinical examination, baseline investigations, bone marrow examination and immunophenotypic analysis.

Results: The patients of acute leukemias presented with varied symptomatology. The predominant symptoms were moderate- to high-grade fever (94%), bleeding manifestations (52%) [From single site (36%), i.e., epistaxis, hemoptysis, gum bleeding, melena, per vaginal. From multiple sites (16%)], weight loss in (14%), bone and joint pain in (14%), edema in 12%.

The general physical examination showed lymphadenopathy in 25(50%), hepatosplenomegaly in 11(22%), hepatomegaly in 4(8%) splenomegaly in 9(18%), skin (rashes) in 8(16%), and retinal hemorrhage in 8(16%). Hematological profile of the patients showed mean hemoglobin as 7.3 g/dL, mean total leukocyte counts as 47,343.60/mm3 and mean platelet count as 0.523 lac/mm3.

Presence of blasts on peripheral blood film was found in 44(88%) cases. BMA study showed AML in 27(54%), ALL in 7(14%), acute leukemias (not further classified) in 14(28%) and undifferentiated leukemia in 2(4%).

Flow cytometry revealed AML in 25(50%), ALL in 15(30%), acute leukemia with aberrant expression in 9(18%) and undifferentiated leukemia in 1(2%).

Correlation between morphological and immunophenotypic characteristics of acute leukemias showed that concordance was found in 32 patients (64%) and discordance was seen in 18 patients (36%).

Conclusion: Acute leukemias can present with varied symptomatology. Its occurrence was found to be higher among the males and in age group of (21-30 years). Flow cytometry can detect leukemia earlier, can classify leukemia to AML, ALL and leukemia with aberrant expression better as compared to morphological studies.


Keywords


AML (acute myeloid leukemia), ALL (acute lymphoid leukemia)

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References


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