Bleeding occurs in the skin and mucosal surfaces, with gingival bleeding, epistaxis, or menorrhagia. Less commonly, widespread bleeding is seen in patients with disseminated intravascular coagulation.
BCR/ABL
1.细胞形态学：骨髓象
Normal bone marrow
AML marrow
白血病细胞的染色图片示例
Auer小体
组织化学染色
AML-M0.
AML-M1 AML-M2 AML-M3 AML-M4
FAB分类
定义
(急性髓细胞白血病微分化型minimally differentiated AML)骨髓 原始细胞>30%, 光镜下似L2型细胞，Auer小体阴性，光镜下MPO及 苏丹黑B<3%；电镜下MPO阳性。CD33或CD13可阳性，淋巴系抗原 阴性。
白血病的临断
1
及治疗原则
2
熟悉分型
3
了解病因及流行病学情况
一、概念
是一类起源于造血干细胞的恶性疾病。其克隆中的白 血病细胞失去了进一步分化成熟能力而停滞在细胞发育的 不同阶段，使造血组织中白血病细胞大量增殖，伴其他器 官和组织的广泛浸润，导致正常造血受抑。
Clinical findings
ØInfection Infection is due to neutropenia.
gram-negative bacteria or fungi.
Common presentations include cellulitis, pneumonia, and perirectal infections. Septicemia in severely neutropenic patients can cause death within a few hours if treatment with appropriate antibiotics is delayed.
Clinical findings
ØLeukemic cells infiltrate organs and tissues
(1) Enlargement of the liver, spleen and lymphnodes.
(2) Bone and joint pain
(3) Granulocytic sarcoma
二、发病情况
➢ 年发病率2.76/10万； ➢ 儿童及35岁以下成人中恶性肿瘤死亡率第一位； ➢ 我国急性白血病:慢性=5.5:1,AML>ALL,儿童ALL多见。慢
性白血病中CML>CLL； ➢ 男性>女性；
三、病因和发病机制
不完全清楚，但不是单一因素引起 ➢ 生物因素 ➢ 物理因素：电离辐射 ➢ 化学因素 ➢ 遗传因素 ➢ 其它血液病：慢粒、真红、骨纤、MDS等
M1(急性粒细胞白血病未分化型AML without maturation) 原粒细胞（Ⅰ型+Ⅱ型）占非红系有核细胞（NEC）≥90%，MPO
急性白血病
(Acute leukemia)
一、临床表现
贫血 Anemia
AL
出血 Bleeding
发热 Infection
浸润 Infiltration 淋巴结、肝脾 骨骼和关节 眼部 口腔和皮肤 中枢神经系统白血病 睾丸
Clinical findings
Because of the proliferation of abnormal blast cells in the marrow，the normal cells in marrow are depressed. ØAnemia ØBleeding
M:morphology I:immunology C:cytogenetics M:molecular
二、MICM分型
形态学 (Morphology)
免疫学 （Immunology）
细胞遗传学 （Cytogenetics）
分子生物学 （Molecular biology）
急性淋巴细胞白血病 (Acute lymphocytic leukemia ，ALL)
skin and gum：M4, M5
orbit: M3
(4) Central nervous system leukemia: ALL, M4, M5, M2
(5) Testis hypertrophy: ALL
二、MICM分型 历史
Ø1976-1986 M(FAB type) Ø1986-2001 MIC type Ø2001-now MICM(WHO type)
急性非淋巴细胞白血病 (Acute nonlymphocytic leukemia，ANLL)
或急性髓系白血病 (Acute myelogenous leukemia， AML)
髓系、淋系、系列非特异性抗原
M2 t(8;21) t(6;9) M3 t(15;17) M4 inv(16)
AML1/ETO、PML/RAR、 CBF/MYH11、MLL abnormalites
Granulocytic sarcoma is a tumor composed of myeloblasts or monoblasts. These tumors may be found in any location, especially the skin, gum, orbit, genitourinary tract（especially testis），central or peripheral nervous system. These tumors were originally called chloromas because of the green color imparted by the heavy concentration of the enzyme myeloperoxidase present in leukemic cells.