[Music] welcome back guys now in this video let's discuss about acute leukemias so acute leukemias so you know it acute leukemias are the cancer of blood usually we call it as the blood cancer right so here what exactly do we mean by acute leukemias in order to understand this first let's recap the normal hematop pois process the process the flow chart of the normal hopis you already know it but let's do it in a quick time hematopoetic stem cell there is a hematopoetic stem cell which is cd34 positive this hematopoetic stem cell is going to divide into myoid blasts okay myoid stem cell you can also call it as a myoid blast and lymphoid blast okay now this myoid blast is going to further divide into err blast myoblast Moro blast and mega Caro blast okay now from this arthr blast we are going to have the mature cells that is the RBC the myoblast is going to produce the Grano sites which includes the neutrophils okay the neutrophils basophils as well as eosinophils okay these are the mature cells monoblast is going to give R to monoc sites and megao blasts are going to give us to the mega Cario sites which are nothing but the plat now already we have discussed that the myoid blast is going to divide into two types see this Milo sorry not myoid blast the lympho blast okay the lymphoid blast the lymphoblast can be of B lymphoblast okay B lymphoblast are T lymphoblast it can divide into B lymphoblast and T lymphoblast this B lymphoblasts are going to form the B cells which on activation becomes plasma cells the plasma cells are the ones which produce the antibodies the T lymphoblasts are going to form the T cells that is CD4 positive tper cells and cd8 positive T cytotoxic cells so CD4 positive cd8 positive t- cells okay T lymphocytes so we have the B lymphocytes we have the T lymphocytes which are coming from the lymphoid Blaster the lymphoid lineage so there are two lineages which is a myoid lineage as well as well as a lymphoid lineage right right now what exactly is acute leukemias see acute leukemias are the problems ofid cells acute leukemias of the problems of blasts it's the problems of the blasts okay so blastic cells so these blastic cells are proliferating so much okay so let me highlight here see whatever I have highlighted here all these are the immature cells the plastic cells are proliferating too much there is a neoplas proliferation of the blasts immature cells are getting crowded in the blood too much amount of cells are getting crowded in the blood which cells immature cells which IM cells all these are the wbcs okay so acute leukemias are the neoplastic proliferation of the blasts so let me write here acute there is nothing cute about acute leukemias which are bad things right these are the cancers acute leukemias so what exactly are they they are neoplastic proliferation of of blasts they're defined as the neoplastic proliferation of blast now you can ask me sir how much Blast for example I have seen this this number of blast in the blood or this number of blast in the bone marrow so can I call it as acute acute leukemia see to Define it as a acute leukemia yes there is a neoplastic proliferation of blast but how much more than 20% of the bone marrow okay see it's a neoplastic proliferation of the blast are defined as more than 20% blasts immature cells in bone marrow okay more than 20% of the blast seen inside the bone marrow so you have taken the bone marrow bapsy and in the bone marrow bapsy if you see out of all the cells if you see more than 20% blasts then you can say this is acute leukemia croing off blast everywhere there is a blast Okay now what's the problem sir if you ask me see the entire bone marrow is getting crowded because of this blast crowded out so what what's the problem see more number of cells is there is that's good right no that's definitely not good because the blasts are going to occupy totally occupy the bone marrow so the normal function the physiologic function of the bone marrow is going to be compromised so the patient is going to suffer with anemia because the normal functions are getting like you know the normal function is now not happening because of this blast okay so anemia is going to be there this anemia is going to cause a fatig anemia is going to cause a fatig easy fatigability is going to be seen in the females or the males okay or the patient is going to have neutropenia or you can say leucopenia anemia lucco penia so why leucopenia neutropenia can be SE because total blast everywhere there's the blast blast are not the mature cells the immature cells so this leucopenia or you can say the neutropenia is the one which is going to cause recurrent infections next there can be thrombocytopenia thrombocytopenia means the platelets are going down as the platelets are going down the patient is going to have bleeding okay bleeding disorders bleeding into the skin bleeding into the joints kind of thing so at the end of the day the point which I want you to know is acute leukemia as the main main problem the totally bone marrow is crowded out with this immature cells which are blast more than how much more than 20% that's an McQ because of the accumulation of this blast the normal production of RBC WBC blets is going to be hampered which is going to cause anemia or bleeding disorders or recurrent infections so in a one word I can say there is pan cenia there is pan cytopenia pan means all cytopenia cytopenia are going to be seen okay in acute leukemias now the next point which I want you to know is classification okay acute leukemias are classified into how many types now just look at this image okay just look at this image and tell me see how many types of blasts are there there are two types of blast there is myoid blast and lympo blast so acute leukemias are divided into acute myoid leukemias or acute myogenous leukemias acute lymphoid leukemias or lymphoblastic leukemias so there are two types of acute leukemias two types what are they one is AML acute myogenous leukemia there are different types of AML that's a totally different thing but broadly classifying there are AML acute myoblastic leukemia acute myogenous leukemia where the myoid blasts are proliferating so much there is more than 20% accumulation of the myoid blasts and there can be Al L acute lympo blastic leukemia okay so always the one point which I want you to know acute means blasts acute means immature cells okay so myoblasts lymphoblast acute mil logous you can say acute myogenous leukemia acute myoblastic leukemia acute lymphoblastic leukemia okay so how to differentiate between them okay that we will discuss um like in upcoming uh slides we can discuss about that first let's begin with the acute lymphoblastic leukemia okay a l l so let's begin with this acute lympo blastic leukemia now my question to you sir what exactly is acute lymphoblastic glucemia you should know acute lymphoblastic glucemia means more than 20% of the blast which blasts lymphoblast in the bone marrow there is more than 20% of the lymphoblasts okay so let me write here neoplastic proliferation of lymphoblast where in bone marrow okay so now my question is how to differentiate how to say this is a lymphoblast this is not a myoblast this is a lymphoblast how can we say see acute lemas can be of two types that it can be acute myoblastic glucemia or acute lymphoblastic glucemia how to say this is a lymphoblast this is not a myoblast this is a lymphoblast how to say see this lymphoblast uh positive for something called as tdt the tdt positive will be seen okay DDD it's a DNA polymerase a DNA polymerase tdd stands for terminal deoxy transferase okay termal deoxy transferase which is a DNA polymerase which is present specifically in the lympo blast not in the myoid blast okay not in the Milo blast it's it's not present it's not even present in the mature T lymphocytes okay it's not present in mature T lymphocytes or B lympocytes in mature cells is not there it's present in the lymphoblast that's it so tdt positivity is going to be seen now my question to you is Sir this Al okay acute lymphoblastic leukemia in which people we will see this Al this Al is most commonly seen in children okay it's going to be most commonly seen in children that two most commonly seen in children with Down Syndrome okay that two after 5 years before 5 years the Downs patients are at a risk of getting a different type of WBC cancer a different type of cancer which is called as a um mega Cario blastic leukemia that's a total different thing now my point is Down syndrome patients Downs babies before 5 years of age they will get a different type of acute leukemia after 5 years they're at a more risk of getting Al that is acute lymphoblastic leukemia okay now sir look at this flowchart once look at this flow chart right now I'm discussing about a l l that is acute which is a blast acute lymphoblastic leukemia my question to you how many types of lymphoblasts are there lymphoblast or lymphoid Blast how many types of lymphoblast are there there is a b lymphoblast which will give R to the B cells and there is a t lymphoblast which will give rise to the T cells okay CD4 positive and cd8 positive T cells so how many types of Al is possible so Al can be also of two types A can be of B simply call as a ball and T simply col is at all so b means B type it's a b lymphoblast b b means B acute lymol blastic glucemia t means T acute lymphoblastic glucemia now simple so what is BL now imagine there is a baby who is having BL okay there is a baby who is having a BL BL means if we say that this fellow is having a b which means it's a neoplastic proliferation of okay neoplastic proliferation and accumulation of neoplastic accumulation of B lymphoblast neuroblastic accumulation of which cells B lymphoblast in bone marrow these cells the be lymphoblast it's a lymphoblast right so definitely it is tdt positive it's a tdt is going to be tdt positive okay now what is a t sir T is also same thing it's a neoplastic accumulation it's a neuroplastic accumulation of T lymphoblast in bone marrow okay which are also the steo blast are also tdt positive they're also D positive so at the end of the day the point which I want you to know is Sir Al is of two types Al is most normally seen the children okay the downies but Al is of two types what are the two types of Al B and T okay B acute lymphoblastic lukemia T acute lymphoblastic glucemia my question is sir we can differentiate we can differentiate acute lymphoblastic leukemias from acute myoid leukemias Okay acute myoid leukemias and acute lymphoblastic leukemias we can differentiate based on the tdd positivity if a blast is having tdt definitely we can say this is a lymph blast but how to differentiate between B and T how to differentiate whether the blast is a B cell or whether it's a t lymphoblast b lymol blast or t lympo Blast how to differentiate see B lymphoblasts are having different types of surface Mass markers the lymo blasts are having different types of surface markers now on B lymphoblasts it's a b okay B lymphoblast are going to have certain CD markers especially on B what do you have is CD 10 positivity cluster designation CD 10 will be there CD 19 as well as CD 20 if it is B these things will be there BL children these these the blasts okay the blasts are going to show cd10 cd19 or cd20 positivity if it is a t okay if it's a t on T there will be positivity from CD 22 CD 8 positivity is going to be seen anywhere between CD 2 3 4 5 6 7 8 something like that okay so these markers are going to be seen so B is differentiated from T based on the surface markers okay now important points about the BL let me write here b a l that is B acute lymphoblastic lukemia see it's the most common type of Al okay it's the most common type of Al don't forget what are the two types of Al ball and Tall B and T out of two what is most common B is most common okay now it is having a very good prognosis when compared to the other good prognosis the prognosis thing is based B on different like you know cytogenetic mutation that we will discuss but B most common type of Al okay so the cells are going to express this B cells are going to express here itself let me write are going to express tdt positivity is going to be seen as well as markers that is CD 10 19 and 20 positivity is going to be seen now I have said you the prognosis is usually good but the prognosis is based on cytogen abnormalities see if a person okay if there is a boy who is having this BL because of a mutation or a translocation same for example translocation 12 21 okay 1221 if this is the translocation that is there okay this is the translocation that is there that's going to have the good prognosis 12 21 translocation is going to show good prognosis and this is usually in the children if the translocation is 922 translocation translocation 922 usually this translocation 922 is going to result in a chromosome okay translocation between the 9 and 22 chromosomes okay that's going to cause a Philadelphia chromosome Philadelphia chromosome which is usually seen with the CML type of cancer chronic myogenous leukemia is a total different type of cancer we will discuss in The Chronic leukemias if a patient is having 922 translocation which is usually seen with the CML but that's okay now if this translocation is there it can also cause B it can also lead to BL but the prognosis is going to be bad prognosis okay so prognosis is a dependent on the cytogenetic abnormality both translocation 1221 and translocation 922 can both lead to the BL but translocation 1221 is going to have the good prognosis translocation 922 which is resulting in the Philadelphia chromosome is going to have the bad prognosis okay but if the patient is having this type good prognosis is going to have a very excellent response to the chemotherapy okay excellent response to chemotherapy excellent response to the chemotherapy but important point is this B cells okay they will go into the test they will go into the central nervous system whatever so whatever the chemotherapy you are giving see it's a blood cancer right the blasts are there blast immature cells are going to come into the bloodstream so everywhere there is blast so these blastic cells we have to Target these blastic cells and we have to kill these blastic cells we know the WBC they can they have a propensity to go into the tissues okay they have a capability to enter into the tissues so this blasts also can enter into the vingers can enter into the brain they can enter the scrotum so whatever the chemotherapy you are giving that chemotherapy is going to kill only the blasts which are there in the blood so you have to cross you have to do something which can cross the bloodb brain barrier and you have to do something which can cross the blood testicular barrier so the point which I want you to know is we have to do the prophylactic okay prophylactic chemotherapy should be done so important point propy AIS to scrotum and Central n system okay so profile access should be done to the scrotum as well as the cerebros spinal fluid we have to inject something which can cross this so that the patient won't develop um the recurrence of this cancer in the future okay so this is the important point which I want you to know now B is completed okay first type of first type of acute lymphoblastic glucemia that is B is completed now let's discuss about t now tell me what exactly is T so Al acute lymphoblastic lukemia which lymphoblast sir it's a t lymphoblast so this T lymphoblast are accumulating inside the bone marrow more than how much percent more than 20% of the bone marrow now what they will do they will crowd out the bone marrow which is going to lead to the panetas like anemia can be seen neutropenia can be seen and trombocytopenia can be seen you know it you know all the stuff but how can we say that this is a t this is TL sir the cells are going to be tdd positivity they will show tdd positivity also the cells are going to show the positivity for the mark CD 2 to cd8 positivity these cells will have positivity for cd22 to cd8 okay cd2 to cd8 positivity important point is this is going to especially affect the teenagers okay T4 I used to remember like T for teenagers okay so te- cells we know it te- cells will go to the thus okay for maturation for the process of maturation t- cells will go to the thymus the education of the T cells is happening in the thymus so all this blasts will go into the thus and there they will start to proliferate so if you look at the thymus thymus is going to become big so there will be thymic Mass teenagers are going to present with a media stal Mass are the thymic mass okay Thoma okay th make Mass so whenever this cells whenever they are forming a solid Mass a solid lump okay before B it's all like a liquid the cancer which is it's a liquid tumor okay but whenever these cancerous cells okay the WBC whenever these blastic cells immature cells whenever they are forming a mass kind of thing then you have to call it as lymphoma so T you can also call it as a lymphoma okay so now I'm going to call it as T acute lymphoblastic lymphoma is it's not a leukemia leukemia is a liquid cancer okay liquid the cancerous cells which are present in the bone marrow and the immature cells which are freely circulating in the blood but when it is forming a mass you have to call it as acute lympo blastic lymphoma okay acute lymphoblastic lymphoma because it's forming a thymic mass now what else you have to know see I have already discussed all the important points B acute lias are of two types ba acute lemas especially the acute lymphoblastic lemas Okay acute lymphoblastic lemas are of two types one is B and T how to differentiate between them all the lymphoblasts are going to express that tdd I it and how to differentiate between BL and T B is going to be differentiated from T based on the surface markers surface markers and one thing this T see T cells do not express very important do not Express at any time do not express cd10 cd10 is of besels here I have explain you cd10 it is going to be seen on bells it's never seen on going to be it's never going to be seen on the T lymphoblast okay guys now we have completed the acute lymphoblastic leukemias now in the next video we'll be mainly concentrating on the acute myoid leukemia or acute myoblastic leukemias hope the video is helpful thank you