Leukaemia

Dr. Ivy Ekem 11.05.05

Outline

• What is leukaemia • Blood, blood cells and their function • Production of blood cells • Leukaemia and its associations • Epidemiology • The numbers at Korle-Bu • How does it present • Diagnosis • Treatment and costs • Needs at Korle-Bu

What is leukaemia

• blood disease • uncontrolled increase in the production of blood cells • mature (fully developed and thus retain some function) or • immature (undeveloped and thus no normal function). • Cancer.

Blood

• blood is made up of a fluid part and a “solid” part. • The fluid part: mainly water with some proteins, fats, sugars, salts, as well as waste products on their way to excretion. • the solid part is made up of cells

Blood cells and their function

• red cells: carry oxygen from the lungs to the rest of the body and carbon dioxide back to the lungs for exhalation • white cells which are of five different types; fight infections and other foreign invaders • platelets whose function is to assist clotting once there is an injury.

Production of blood cells

• by the bone marrow – as needed by the body and within closely controlled limits.

• They all develop from one primitive cell called the stem cell and go through various stages of maturation subject to control.

Leukaemia and its associations

• In leukaemia, the control in cell production is lost.

• the control mechanisms inside the cell and/or its environment are lost • the cell becomes abnormal and unresponsive to any control. • in any particular individual the cause cannot always be pinpointed, but through research, it is known that the development of a “cancerous cell” is a multi-step process, i.e. a series of events or injuries to the cell finally result in it getting out of control.

• These events can be grouped into two; genetic and environmental.

• The genetic factors may be inherited or acquired whilst in the womb. • The environmental factors include poisonous chemicals and dyes, pesticides and herbicides, benzene and benzene products e.g. as in rubber solvents, radiation in different forms, certain infections and drugs. • These may get to the body through ingestion, inhalation, or absorption/passage through the skin.

Epidemiology

• Affects all groups of persons; • young and old, rich and poor, white and black, male and female. • Within any group though, different types of the disease are more common. • The rate at which the disease is seen at Korle-Bu Teaching Hospital is increasing. • May be due to an increase in the environmental factors mentioned above especially with regard to the indiscriminate use of these agents in agriculture, be it land produce or fish farming food, in food and drink processing and in other forms of industry

Types of Leukaemia

• By virtue of the way in which those affected show up, leukaemia is broadly divided into two groups • acute leukaemia • chronic leukaemia.

The Numbers at Korle Bu

Leukaemias seen at Korle Bu Hospital from 1st January to 31st December, 2004 Age ALL AML CML CLL <=12yr >=13yr SubTotals

15 20 35 7 8 15 2 23 25 0 25 25

Total Acute Grand Total 50 Total Chronic 50

100

A comparison of the total number of leukaemias seen at Korle Bu Hospital in the years 2004 and 2005 for the period 1st January to 30th April.

Year 2004 Age <=12yr >=13yr 2005 <=12yr >=13yr ALL

3 7

Total Acute

8 9

Total Acute AML

1 1

12

0 7

24 CML

0 4

Total Chronic

0 12

Total Chronic CLL

0 11

15

0 7

19

Total leukaemias, 2004

5 0 15 10 30 25 20 ALL AML

Type

CML CLL =<12yr =>13yr

5 0 30 25 20 15 10

Leukaemias, 2004 vs 2005 (1st Jan - 30th April)

Acute

Type of leukaemia

Chronic 2004 2005

Normal blood

Acute Leukaemia

Chronic leukaemia

A.E

Presentation

• Acute leukaemia makes a person feel ill within a short period of time (weeks), and diagnosis and treatment must be fast to give the patient the best chance of a good response or cure.

• Chronic leukaemia may go on for a long time (months) before the affected person feels unwell. The urgency for treatment, unlike acute leukaemia, is of less significance

• acute leukaemia, his or her ability to make red cells, normal white cells and platelets goes down remarkably, therefore they get anemia, suffer from infections and bleed easily. • the glands in their neck, armpits and groins may be enlarged. As a quick caution, not everyone with any of these symptoms has acute leukaemia, there are many other causes. • early reporting to the hospital makes a difference in the outcome. • In the person with chronic leukaemia, the early symptoms include enlargement of the glands and/or the abdomen (on account of an enlarged spleen) and may be noticed by the individuals themselves, relatives, or the doctor.

Diagnosis

• examination of the blood and bone marrow.

Treatment

• Treatment is very intensive, expensive and complicated in acute leukaemia, often requiring hospital admission. That of chronic leukaemia, is comparatively simpler, and can be done almost entirely on outpatient basis. • In some cases, a procedure aimed at replacing the diseased bone marrow with healthy stem cells to produce normal cells may be required. This is called the stem cell or bone marrow transplant. We do not have that facility currently. It is hoped that in future this may become available.

Needs

• Support for the patient – Treatment costs (40-60m within first yesr in acute leukaemia) – psychological • Support for the department – Ward – Support facilities – Research and development

• Thank you