Leukemia

Overview and Introduction to Bone marrow aspiration

The soft material in the center of bones is the bone marrow. In some bones, the bone marrow consists only of fat. Other bones contain what is termed cellular marrow. The cellular marrow has different types of cells that give rise to red cells, white cells and platelets for our blood. The marrow may also contain abnormal cells, proteins, or inflammatory processed that are not normally present, such as cancer cells. Since the production of red cells requires iron, the marrow is one of the places in the body that normally stores a supply of iron.

Bone Marrow Aspiration

Bone marrow aspiration is the removal of a small amount of this tissue in liquid form for examination. The bone marrow biopsy and aspiration procedure provides information about the status of and capability for blood cell production.
A bone marrow aspiration and/or biopsy may be ordered to help evaluate blood cell production, to help diagnose leukemia, to help diagnose a bone marrow disorder, to help diagnose and stage a variety of other types of cancer that may have spread into the marrow, and to help determine whether a severe anemia is due to decreased RBC production, increased loss, abnormal RBC production, and/or to a vitamin or mineral deficiency or excess.

Bone Marrow Procedure

A bone marrow aspiration procedure is a technique used to obtain the blood-forming portion (marrow) of the inner core of bone for examination in the laboratory or for transplantation.
The bone marrow consists of inserting a special needle into a bone that contains marrow and withdrawing the marrow by suction or coring out a sample of the marrow.

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Acute lymphoblastic leukemia (ALL) in children

Childhood acute lymphoblastic leukemia (also called acute lymphocytic leukemia or ALL) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. It is the most common type of cancer in children.
ALL is a leukemia occurring mostly in children under age four, although older children and adults can also be affected; Caucasian boys are most likely to develop ALL. ALL accounts for 23 percent of cancers in those under age 15,
The causes of ALL are unknown, but the disease is more common in those with Down Syndrome and who were exposed to radiation prenatally.

Symptoms of ALL in Children

- ALL starts suddenly, often after a four to six week illness characterized by bone pain, joint swelling, and easy bruisability.
- Symptoms of ALL include fatigue and pallor from anemia, a decrease in red blood cells, and excessive bleeding and bruising from a decrease in platelets.
- Bone and joint pain are caused by excess lymphocytes in the bone marrow.
- If leukemia affects the brain, headaches, irritability and vomiting may occur.

Diagnosis of ALL in children

- Diagnosing ALL begins with a medical history and physical examination, complete blood count, and blood smears.
- Pathological examination, cyto-genetics and immunophenotyping, establish whether the “blast” cells began from the B lymphocytes or T lymphocytes.
- DNA testing can establish how aggressive the disease is; different mutations have been associated with shorter or longer survival.
- Medical imaging (such as ultrasound or CT scanning) can find invasion of other organs commonly the lung, liver, spleen, lymph nodes, brain, kidneys and reproductive organs.

Treatment of ALL in children

Treatment for acute leukemia can include chemotherapy, steroids, radiation therapy, intensive combined treatments (including bone marrow or stem cell transplants), and growth factors.
Chemotherapy treatment is very effective and starts with an induction phase, where the fast growing cancer cells are destroyed over several weeks. The consolidation phase of chemotherapy may last as long as several years. Chemotherapy drugs may be injected into the fluid around the brain, followed by radiation, because the cancer cells so often spread to the brain.
If relapse occurs, stem cell transplant may offer the best chance for a cure, but has serious risks and side effects that can be fatal. Siblings or other family members or donors with compatible tissue, or HLA match, can be used.

Leukemia in children and its symptoms

Leukemia is a cancer of the bone marrow, the spongy center of the bones that makes blood cells. In leukemia, abnormal white blood cells divide out of control and crowd out the normal cells in the bloodstream. The abnormal white blood cells are not mature, and therefore cannot carry out their infection-fighting function in the blood.

Leukemia in children

Leukemia affects children too, and the number of child leukemia cases keeps increasing.
There are two types of leukemia – acute leukemia – a cancer that develops and evolves very fast and it affects all the white blood cells, and chronic leukemia – it develops slower and healthy white blood cells can still be found. More than 95% of the child leukemia cases are acute leukemia.
Signs and Symptoms of Childhood Leukemia
- Infection : A child with leukemia may develop an infection that doesn’t respond to antibiotics, have a high fever, and become very sick.
- Easy bleeding or bruising : A child with leukemia may bruise easily or have increased bleeding from small cuts and nosebleeds.
- Bone pain : This is due to accumulation of the leukemia cells underneath the covering of the surface of the bone or inside the joint.
- Swelling of the abdomen : Leukemia often causes enlargement of the liver and spleen.
- Swollen lymph nodes : Swelling of lymph nodes inside the chest or abdomen may also occur. These are sometimes detected only by imaging tests, such as CT or MRI scans.
- Enlargement of the thymus : Enlargement of the thymus or of lymph nodes inside the chest can compress the nearby trachea (windpipe). This can lead to coughing, shortness of breath, or even suffocation.
- Headache, seizures, vomiting: Leukemia cells can spread outside the bone marrow. This is called “extramedullary spread.” It may involve the central nervous system (brain and spinal cord), the testicles, ovaries, kidneys, lungs, heart, intestines, or other organs.