Chronic leukemia monotsytarnыy

Under chronic monocytic leukemia meant tumor process, characterized by a significant increase in the blood and bone marrow cells monotsitopodobnyh at normal or low leukocytosis.

Side by side cases of chronic monocytic leukemia, in which the long-term suppression of erythrocyte detected and platelet sprouts, there are also cases with early appearance of refractory anemia therapy, which in a few years may be the sole manifestation of disease.

Since the increase in the number of monocytes and monocytoid cells in the peripheral blood can carry and reactive, such as for tuberculosis, Cancer, for the diagnosis of chronic monocytic leukemia need to monitor the dynamics of the blood for a certain period to avoid systemic diseases, can cause reactive monocytosis.

Sick chronic monocytic leukemia mainly persons over the age of 50 years.

The clinical picture of chronic monocytic leukemia

The clinical picture of the disease for a long time did not have any specific features. A retrospective analysis of patients outpatients shows, that their health is violated only in 3-4 years after the discovery of a high percentage of blood monocytes. Asymptomatic chronic monocytic leukemia is distinguished from reactive monocytosis, testifying, usually, the intensification of the process, he caused (tuberculosis, sarcoma, etc.. d.). It can be assumed, chronic monocytic leukemia that actually occurs much more frequently, than diagnosed. Anemia, usually, It has norm- hyperchromic or character.

Enlargement of the spleen observed in about half of patients; a substantial increase in liver, as well as lymph node enlargement, not observed.

Blood picture of chronic monocytic leukemia

The painting is characterized by a lack of blood also expressed manifestations. A small degree of change in the peripheral blood recalls the beginning of chronic lymphocytic leukemia, when at a normal level of white blood cells observed only moderate lymphocytosis. Bone marrow blood for a long time while leukemia hardly broken. Leykoeritroidnoe ratio close to normal, although trepanate found polymorphonuclear cell hyperplasia of the bone marrow, and large mononuclear cells do not form large clusters.

In typical cases of leukemia morphology of monocytes is no different to any peculiarities, so in these patients it for years is not regarded as a sign of tumor. In some cases, the disease may appear monocytes with some peculiar morphology: they have little bean-shaped nucleus of rough structure and almost colorless, with scant cytoplasm, Sometimes dust grit. In the study of the blood of the same patient in different laboratories, these cells are taken for the monocytes, then for myelocytes. Sometimes monocytes are intricately jagged contours. The appearance of young forms - promonotsitov and monoblastov - can be seen almost exclusively in the terminal stage of the disease.

In the blood of patients with chronic monocytic leukemia are often found isolated nucleated red cell number.

Most patients showed a significant increase in ESR, that in some cases it may be one of the earliest signs of disease laboratory. When analyzing karyological violation number and structure of chromosomes can not be detected.

In acute and chronic monocytic leukemia in blood serum and urine of patients contains a large amount of lysozyme, which may be ten times greater than normal levels of the enzyme. So, if normal serum detected 4-7 pg / mL lysozyme, then for monocytic leukemia its level of 40-150 mg / ml, and in urine can reach 24-420 ug / ml and higher. On this basis can be differentiated monocytic leukemia and other leukemia monocytic leukemoid reactions, in which the content of lysozyme in serum and urine is increased if, it is not so dramatically.

Thus, chronic monocytic leukemia diagnosis is based on increased number of monocytes in the blood and bone marrow (often less, than in blood), polymorphonuclear cell hyperplasia in bone marrow trepanate, detecting diffuse cell proliferation, and detecting a high level of lysozyme in serum and urine in a patient.

Myelomonotsytarnыy leukemia

Embodiment chronic monocytic leukemia is myelomonocytic leukemia, wherein in the blood and bone marrow is observed not only monocytosis, and increased content of myelocytes. Morphologically individual cells are difficult to be attributed with certainty to the monocytes and myelocytes. Cytochemical they detect symptoms as granulocyte, and monocyte germ. The clinical picture of chronic myelomonocytic leukemia a little different from the picture monocytic leukemia, but more often an increase in the spleen. With the development of the pathological process suppression signs of normal hematopoiesis Rastko become more pronounced, and even before the terminal stage revealed moderate thrombocytopenia and anemia to some extent.

Chronic monocytic leukemia in children

Along with the chronic monocytic leukemia in people older than 50-60 years, isolated chronic monocytic leukemia in children. This form is even rarer first, it is observed only pediatricians. As in adults with chronic monocytic leukemia, children basic characteristic of the process is a constant monocytosis. This feature can be taken as a manifestation of hereditary neutropenia, which is also characterized by monocytosis.

The assumption of a hereditary neutropenia may seem the more legitimate, that both the disease occurs in childhood and may show up in the neonatal period. In reality blood picture of chronic monocytic leukemia is different from the, which is observed in hereditary neutropenia. The main difference is that, that chronic monocytic leukemia neutrophils in the blood are constantly, possible even a slight shift to the left leukogram, although sometimes marked neutropenia varying degrees.

In chronic monocytic leukemia in children are often observed leukocytosis, hepatosplenomegaly, which is not typical for hereditary neutropenia. The first detection of these changes can be suspected infectious mononucleosis, especially if they are combined with fever, catarrhal symptoms in the nasal part of the pharynx, anginoi, which can often be observed in this form of leukemia in children, especially in cases with severe neutropenia. However, the continued availability of monocytosis with repeated blood test evidence for leukemia and required to confirm the diagnosis of trepanobiopsy and bone marrow puncture.

In trepanate in chronic monocytic leukemia in a child, As with adults, marked myeloid hyperplasia polymorphic, although pockets of accumulations of monocytes may be more distinct, than adult. Contents monocytoid cells in bone marrow increased and sometimes may reach tens of percent, and along with the monocytes found promonotsity and even blasts.

In this type of end-stage chronic leukemia blood and bone marrow appears blastosis, increased liver and spleen, often appears hyperthermia, not due to any infection it was.

In some cases, chronic monocytic leukemia in children, along with monocytosis may be characterized by a significant increase in density and submandibular lymph nodes, containing predominantly mature monocytic elements.