European Journal of Cardiovascular Medicine

Leukemia is a morbid condition of unknown etiology and fatal termination which is characterized by widespread proliferation of leukocytes and their precursors in the tissues of body and usually associated with qualitative and quantitative changes in circulating white cells of the blood. The high incidence of AML is seen in adults, accounting for almost 80% of acute leukemia in adults and only 20% of acute leukemias in children ^[1] In patients with acute myeloid leukemia (AML), the median age is about seventy years ^[2] the majority of studies have found great occurrence of AML in males, constituting a male to female ratio of 2.5:1^[3]. In 2013, males have been accounted for more than 57 percent of the new cases of leukemia ^[4]. Acute Myeloid Leukemia (AML) is actually a varied selection of wide number of malignant neoplastic diseases that may be grouped on the basis of morphological cytogenetic and also with molecular and genetics criteria ^[5]. The developing countries have greater burden of cancer including haematological malignancies due to population growth, aging and urbanization, changing dietary habits, better control of infections and increasing tobacco consumption ^[6]. The aim of this study is to diagnose and classify leukemia and understand its prevalence and morphology. Distinction between lymphoid and myeloid leukemias is important as treatment/prognosis differs a lot. The hematological malignancies are a group of cancers that arise from a malignant transformation of cells of the bone marrow or the lymphatic system^[5][6]. Haematological malignancies (blood cancers) are the fifth most common cancer group in economically developed regions of the world^[3] .They are traditionally categorised by site according to whether cancer is first detected in the blood (leukaemias), lymph nodes ^[2] (lymphomas - Hodgkin and non-Hodgkin) or bone (myelomas).Stem cells from the bone marrow become blood cells^[1]. They then become progenitor cells, which then become either myeloid progenitor cells or lymphoid progenitor cells.

• Myeloid cells are precursors for red blood cells^[1][2]   ,white blood cells (i.e. granulocytes), and platelets^[5][6]  .
• Lymphoid cells are precursors for white blood cells (i.e. T and B lymphocytes).

Hematological malignancies affect not only the stem and blood cells, but also lymph nodes and other components of the lymphatic system.Essentially, the stem cells are malignant, which make the progenitor cells malignant as well. The causes are highly genetic. Cancer risk assessments and genetic counselling can be provided to those who have a familial predisposition, in addition to preventative measures and long-term follow up.

Aims and objectives:

To analyse the various types and subtypes of hematological malignancies.To find out the prevalence of various hematological malignancies.

All the samples with abnormal hematologic parameters (200) from outdoor and indoor ward patients are submitted to pathology laboratory P.D.U Medical College ,Rajkot from July 2019 to June 2021 over a period of 2 years.

The samples are collected in EDTA vacutte/finger print and afterward run in Automated hematology cell counter. The complete blood counts were done by Nihon hematology analyzer. Normal ranges for TLC, Hb and platelet count taken were 4-11x109 /mm3 , 11.5- 13 gm/d L, and 150-400x109 /mm3 respectively ^[24].The slides are made and stained with different stains like Field’s, Leishman and Giemsa.Bone marrow aspiration /Trephine Biopsy are done in selected cases after proper written consent .A detailed history and physical examination pertaining to leukemia was obtained in each case. Diagnosis of type of leukemia was established on the basis of clinical data, the hematologic findings, morphologic appearance of the abnormal cells . Few cases in remission and others in relapse were also investigated. Estimation of hemoglobin, volume of packed red cells, total leukocyte count, platelet count were done .Smears were stained with Leishman’s stain and differential count was done by counting 200 cells. The general blood picture was also recorded.

Materials needed for study

1)Bone marrow aspiration needle -Sahla bone marrow aspiration needle -18 guage.

2) 10 ml disposable syringe.

3)Glass slides -clean and grease free.

4)Fixative -for routine wet fixation of smears 70-90% methanol in coplin jar

 5)Reagents for Field’s stain , Leishman stain and Giemsa stain.

 6) Sterile gloves, gauze piece and spirit swab.

AGE WISE DISTRIBUTION OF TYPES OF LEUKEMIA

TYPES OF LEUKEMIA -ACUTE AND CHRONIC

GENDER WISE DISTRIBUTION OF LEUKEMIA

DISTRIBUTION OF LEUKEMIA ON THE BASIS OF PLATELET COUNT

DISTRIBUTION OF LEUKEMIA ON BASIS OF TOTAL WHITE BLOOD CELL COUNT

DISTRIBUTION OF HEMOGLOBIN IN VARIOUS TYPES OF LEUKEMIA

In the present study 200 cases were diagnosed as leukemia from all outdoor and indoor blood samples having abnormal hematologic parameters at P.D.U Hospital Rajkot from July 2019 to June 2021 over a period of 2 years.The ratio of male is to female patients of leukemia in present study is 116:84.According to study done at Pramukh Swami Medical College, Karamsad it is 63:47 ,according to study done at Gandhi Medical College it is 31:42 and according to study done at JNU Jaipur it is 86:31.Thus it is clear that the prevalence of leukemia is more in males as compared to females .except in Gandhi Medical College ,Bhopal  study where  it is slightly more in females as compared to males. in our study maximum number of cases of leukemia (24.5%)can be found in the age group of 41-50 years whereas in the study done at Bhopal it is between 31-40 years and 51-60 years (15.06%).In the study done at JNU ,Jaipur it is between 21-30 years.In the study done at Pramukh Swami Medical College ,Karamsad it is between 51-60 years of age(16.36%). prevalence of acute leukemia is more in present study(62.5%) as well as in study done at JNU Jaipur ,Gandhi Medical College Bhopal and Pramukh Swami Medical College. in our study maximum number of cases (37.5%)of leukemia are having hemoglobin in the range of 6.1-9.0 gm/dl.In the study conducted at JNU Jaipur nearly 45.30% of cases of leukemia are also in the range of 6.1-9.0 gm/dl.In the study conducted at Bhopal also maximum number of cases (35.62%)are having hemoglobin in the range of 6.1-9.0gm/dl.In study conducted at Karamsad Medical College also maximum number of cases (37.27%) are having hemoglobin in the range of 6.1-9.0 gm/dl. it is clear that in our study maximum number of cases (48.5%) are having total count in the range of 51000-1,00,000.In the study conducted at JNU, Jaipur maximum number of cases (51.28%) are having total count in the range of 1,01,000 to 1,50,000.In the study conducted at Karamsad Medical College maximum number of cases (36.35%),are having total count in the range of 2,01,000-2,50,000.In the study conducted at Bhopal maximum number of cases (34.14%) are having total count in the range of 1000-51,000. in the present study 67.5% of the cases of leukemia are having platelet count <=50,000.In the study conducted at JNU, Jaipur 38.46% of the cases of leukemia are having platelet count <=50,000.In the study conducted at Karamsad Medical College ,41.81% of cases of leukemia are having platelet count >=1,51,000.In the study conducted at Gandhi Medical College ,Bhopal 50.69% of cases of leukemia are having platelet count >=1,51,000 .

The study was conducted at Department of Pathology at P.D.U Hospital ,Rajkot from  July 2019 to June 2021 over a span of two years.All samples with abnormal hematologic parameters were screened with the youngest patient being 7 months old to oldest being 82 years old . Maximum number of patients were male.Majority of patients were in the age group of 41-50 years with 49(24.5%), followed by 0-10 years with 33(16.50%) and least in > 80 years with 4(2%).Amongst the 200 cases maximum number of patients were having acute leukemia with 125 (62.5%).Amongst them maximum number of patients were having hemoglobin in the range of 6.1-9.0gm/dl with 75 (37.5%) followed by 66 patients (33%) having hemoglobin <=6gm/dl and least having Hb >=12 gm/dl with 10 (5%).Majority of patients in our study were having total W.B.C count in the range of 51000-100,000 with 97(48.5%) followed by 62 patients having total W.B.C count in the range of 1000-50,000(31%) and least in 251000-300,000 with 1(0.5%).Majority of patients in our study were having platelet count <=50,000 with 135 (67.5%) followed by 34 (17%)patients having platelet count between 51,000-100,000 and least 7 (3.5%) having platelet count between 1,01,000-1,50,000.In the present study majority of patients having ALL were in the age group of 0-10 years with 27(93.10%) followed by least with 2 (6.90%) in 11-20 years .Majority of patients with APML were in the age group of 31-40 years with 12 (38.71%) followed by least with 7 ( 22.58%) in 41-50 years.Maximum number of patients with CML were in the age group of 41-50 years with 17 (41.46%) and least in 51-60 years with 11(26.83%).In case of acute blastic leukemia most common age group is 0-10 years with 6(22.22%) and least in 41-50 years with 5(18.52%).Most common age group for AML is 41-50 years with 16 (44.44%) and least common is 21-30 years with 8(22.22%)In case of CLL most common age group is 61-70 years with 13(38.23%) followed by 71-80 years with 12 (35.29%)  and least in 31-40 years . One case of subleukemic leukemia is in between the age group of 11-20 years and 1 in 21-30 years .Most common leukemia in our study is CML with 41(20.5%) followed by AML with 36(18%) and least common is subleukemic leukemia with 2(1%).Bone marrow examination was done in maximum number of  cases of AML with 17(47.22%) followed by ALL with 11(37.95%) and least in CML with 1(2.43%).

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