RISK FACTORS Predisposing: Ionizing radiation (Radiation Therapy) Exposure to chemicals and drugs (melphaplan, cyclosphamide,etc.

e,etc.) Bone marrow hypoplasia (Fanconis anemia, paroxysmal nocturnal hemoglobinuria, and myelodysplastic syndromes) Genetic factors (Down syndrome, blooms syndrome, Klinefelter syndrome, and Fanconis anemia) Immunologic factors (immune deficiencies) Age (Both AML and CLL are more often seen in adults while ALL is commonly seen in children)

Precipitating: Unknown

Can cause

Changes in the normal functioning of the bone marrow.

Further leads to

A decrease in or damage to the hematopoietic stem cells and their microenvironment

Causes

Causes
Causes

Transformation of a single somatic hematopoietic progenitor to a cell incapable of normal differentiation

Further leads to

Dysregulation of myeloid proliferation, maturation, and cell survival.

In which

Oncogenic transformation into a leukemic stem cell occurs at different stages of normal hematopoietic cellular maturation

The marrow is hypercellular with most cells normal.

Causes Which leads to

Leukemic cells to lose its normal property of apoptosis, or programmed cell death.
Which will result to

Translocation of chromosomes (Philadelphia), as the disease progresses

Causes

prolonged life span of leukemic cells and are capable of unrestricted clonal proliferation.
Causes to

Blast crisis to occur which resembles acute leukemia after a relatively slow course for a median period of 4 years,
Resulting to

have favorable competitive advantage over normal hematopoietic cells since transformed cells lack normal regulatory and growth constraints
Results to

Increase numbers of blast cells proliferate in the blood and bone marrow.
Causing

Accumulation of abnormal cells with qualitative defects.

causes

Infiltration of leukemic cells to other bodily tissues, causing many clinically significant complications including CNS involvement, pulmonary dysfunction, or skin and gingival infiltration.
Which further leads to

Blast cells and promyelocytes exceed 20 % in the blood and 30% in the marrow during blast crisis as evidenced by increased fibrotic tissue in the marrow, leukopenia, thrombocytopenia, and anemia.
Which further leads to

CHRONIC LEUKEMIA

ACUTE LEUKEMIA

CLINICAL MANIFESTATIONS:
Respiratory Manifestations:

Integumantary Manifestations:

Ecchymoses Petechiae Open infected lesions Pallor of the conjunctiva, nail beds, palmar creases, and around the mouth.

Dyspnea on exertion.

Neurologic Manifestations:

Gastrointestinal Manifestations:

Fatigue Headache Fever

Bleeding gums Anorexia Weight loss Enlarged liver and spleen

Musculoskeletal Manifestations:

Bone pain Joint swelling and pain.

Renal Manifestations:

Hematuria

Cardiovascular Manifestations:

Tachycardia at basal activity levels. Orthostatic hypotension Palpitations