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Acute leukoses - Practical hematology of children's age

Table of contents
Practical hematology of children's age
Embryonal hemopoiesis
Morfofunktsionalny characteristic of cells of marrow and peripheral blood
Marrow parenchyma cells
Peripheral blood of children of different age
The system of a hemostasis is normal
Etiology and pathogeny of leukoses
Acute leukoses
Acute leukoses - a preleukosis
Possibilities of a predictive assessment of a course of an acute lymphoblastoid leukosis at children
General principles of treatment of an acute leukosis
Chemotherapeutic drugs
Treatment of an acute lymphoblastoid leukosis
Treatment of myeloid forms of an acute leukosis
Infectious complications and symptomatic therapy of an acute leukosis
Consolidation and maintenance therapy of an acute leukosis
Immunotherapy
Remission and recurrence of an acute leukosis
Inborn leukosis
Neuroleukosis
Myelosis
Lymphogranulomatosis
Gematosarkoma
Macrofollicular lymphoma
Angioimmunoblastny lymphadenopathy
Leukemoid tests
Infectious lymphocytosis
Infectious mononucleosis
Leukemoid tests of different types
Dysfunctions of granulocytes
Leukopenias
Histiocytoses
Histiocytoses - an eosinophilic granuloma
Malignant histiocytosis
Family erythrophagocytal histiocytosis
Accumulation diseases
Nimann's illness — Peak
Angiopathies
Hemorrhagic vasculitis (Shenleyn's illness — Genokh)
Mayokki's purpura
Ataxy teleangiectasia
Entsefalotrigeminalny angiomatosis
Kortiko-meningealny diffusion angiomatosis
Cerebroretinal angiomatosis
Hypertrophic gemangiektaziya
Multiple and huge hemangiomas
Elastic fibrodisplaziya
Coagulopathies
Hereditary coagulopathies
Hemophilia And
Clinic of hemophilia
Treatment of hemophilia
Angiohemophilia
Cristmas disease (Kristmas's illness)
Hereditary deficit of factors of XI, XII, XIII and I
Dysfibrinogenemias
Hereditary deficit of factors of VII, X, V and II
Deficit K-vitaminozavisimykh of factors of coagulation
Syndrome of the disseminated intravascular coagulation
Clinic and diagnosis of the IDCS
Treatment of the IDCS
Thrombocytopenia
Idiopathic Werlhof's disease
Clinic and diagnosis of an idiopathic Werlhof's disease
Treatment of an idiopathic Werlhof's disease
Isoimmune Werlhof's disease
Transimmune Werlhof's disease of newborns
Trombogemolitichesky Werlhof's disease (syndrome Moshkovich)
Hereditary Werlhof's diseases
Trobotsitopatiya
Anemias
The anemias connected with blood loss
Chronic posthemorrhagic anemia
Iron deficiency anemias
Clinic and diagnosis of an iron deficiency anemia
Treatment of iron deficiency anemias
Sideroakhrestichesky, sideroblastny anemias
Megaloblastny anemias
Foliyevodefitsitny anemia
Hereditary forms of megaloblastny anemias
Hereditary dizeritropoetichesky anemias
The anemias connected with oppression of proliferation of cells of marrow
Hereditary hypoplastic anemias
Hemolitic anemias
Hemolitic anemias - an ovalocytosis, a hereditary stomatocytosis
Acanthocytosis, piknotsitoz
The hereditary hemolitic anemias connected with disturbance of activity of enzymes of erythrocytes
The hereditary hemolitic anemias connected with disturbance of structure or synthesis of hemoglobin
The acquired immune hemolitic anemias
Isoimmune hemolitic anemias
Treatment of a hemolitic illness of newborns
Autoimmune hemolitic anemias
List of references

Acute leukosis — a malignant tumor which pathological substrate is provided by young people, or blast, cells.
At children's age the acute leukosis in most cases meets. Many decades establishment of the diagnosis of an acute leukosis meant the unfavourable forecast. Rough increase of clinical signs, development of anemia, a hemorrhagic syndrome, necrotic changes, infectious complications within several months led to a lethal outcome. Modern development of science, development of means of polychemotherapy allow to approach treatment of this pathology more optimistically. Also the fact that the best results of treatment of an acute leukosis are achieved at children is pleasant. At an acute lymphoblastoid leukosis the percent of remissions at patients comes nearer to 100. According to the domestic and foreign children's hematologic centers, at a half of children 5 years' remissions are received. About 5% of children have superlong (7 — 10 years) remissions that allows to carry this contingent to recovering from an acute leukosis.
Search of objective criteria of classification of acute leukoses is conducted constantly. Experience demonstrates that morphological features cannot serve as objective criterion of differentiation. At modern therapy of leukoses, considerable extension of life of patients morphological forms of leukemic cells change. The stablest sign are cytochemical properties of blast cells which reflect features of an exchange and are individual at each look. Cytochemical criteria also are the basis for classification of acute leukoses. Different authors offer several options of classifications, however they have no basic character. Allocation of such forms of acute leukoses as lymphoblastoid, miyeloblastny, monoblast, miyelomonoblastny, promiyelotsitarny, an erythremic myelosis and a nondifferentiable form does not raise doubts. The cytochemical characteristic of these forms is provided to tab. 6.

Table 6. Cytochemical characteristic of various options of an acute leukosis (E. N. Mosyagina, N. A. Torubarov, E. B. Vladimirskaya, 1981).

 

 

Cytochemical characteristic

 

 

Option: acute leukosis

Per-
oksi-
basin

Reaction to lipids with Sudan black

Turned sour
bark
fos-
veil -
for

chic -
reaction to a glycogen

a-Naftil-
esterase

Hloratse-
tatestera-
for

Acid
sulfati-
rovanny
mukopoli-
saccharites

Lymphoblastoid

_

_

±

+

  

  

  

Miyeloblastny

+

+

+

+

 

+

Monoblast

±

±

++

±

+

Miyelomonoblastny

+

±

+

±

+

±

Promiyelotsitarny

++

+

±

+ +

±

++

+

Nondifferentiable

Note: N-----reaction positive, ± — slabopolozhitelny,----------------negative.

For practical purposes it should be noted importance of allocation and differentiation of a lymphoblastoid form and group of the miyelomonoblastny nature. Tactics of treatment of the acute lymphoblastoid leukosis which is the most frequent form at children is other than that at other forms of an acute leukosis whereas acute miyeloblastny, monoblast and miyelomonoblastny leukoses are treated according to similar programs. Also the acute promiyelotsitarny leukosis having features of therapeutic tactics is subject to allocation. In classification of acute leukoses such forms as an erythroleukosis, an eosinophilic leukosis, a basphilic leukosis, plazmoblastny option, megakarioblastny option, a low-percentage form of an acute leukosis meet. However allocation of some forms remains diskutabelny, other forms in pediatric practice do not meet.
The clinical course of an acute leukosis at children under the influence of modern methods of therapy underwent qualitative changes. From quickly progressing acute process the leukosis passed into the category of diseases with a long wavy current. Allocate the next periods of a disease: initial, period of a full course of a disease, remission, aggravation and terminal. Now the period of remission is considered obligatory, especially at children with an acute lymphoblastoid leukosis. Long remission (more than 5 years) allows to speak about recovery. Return to kliniko-hematologic displays of an illness is treated as
to pass the recurrence of an acute leukosis able into an end-stage. At an acute lymphoblastoid leukosis at children recurrence of a disease can be stopped and transferred to a remission phase, however, already in smaller percent of cases again, than during the first attack. Allocation of the periods of leukemic process has practical value as in many respects defines the forecast of a disease and therapeutic tactics.



 
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