leukemia fkg edit

7/27/2019 Leukemia FKG Edit

1/29

Leukemia


2/29

Definisi

Leukemia adalah penyakitkeganasan jaringan hemopoietik,

ditandai dengan penggantianelemen-elemen SST normal dengansel darah abnormal (Neoplastik)


3/29

Blood cell components


4/29

Blood cell component

Erythrocyte

Leukocyte:

Granulocyte :

Neutrofil, eosinofil, basofil

Agranulocyte:

Lymphocyte, monocyte

Thrombocyte


5/29

Hematopoietic cell lineages


6/29

Klasifikasi Leukemia

Acute Myeloblastic Leukemia (AML):

M0,M1,M2,M3,M4,M5,M6,M7

Acute Lymphoblastic Leukemia(ALL):

L1,L2,L3

Chronic Myelocytic Leukemia (CML)

Chronic Lymphocytic Leukemia (CLL)


7/29


8/29

Etiologi and Faktor Risiko

Host Factors :

Herediter

Kelainan kromosom kongenital Imunodefisiensi

Disfungsi SST kronik

Faktor lingkungan :

Radiasi

Kimia and obat-obatan

Virus


9/29

Insidensi

Di USA : 8-10 kasus baru/100.000org/tahun.

Meningkat dengan bertambahnyaumur

Rasio dewasa : anak = 10 : 1

Rasio lk : peremp = 1-2 : 1 ALL lebih sering pada anak, AML

lebih sering pada dewasa


10/29

Perbandingan Akut dankronik Leukemia

AkUT kRONIk

umur semua dws

onset Tiba-tiba tanpa

gejala prodormal

Insidious/tersembu

nyi

Course (untreated) < 6 mo 2-6 yr

Sel leukemia Sel muda Sel tua

Anemia Ringan sampai berat ringan

Trombositopenia Ringan sampai berat Ringan/ normal

Hitung leukosit Bervariasi meningkat

Organomegaly Ringan Prominent/jelas


11/29

Gejala klinis Leukemia akut

Patogenesis Gejala klinis

Kegagalan sumsum tulang

Anemia Fatigue, malaise, pallor

Trombositopenia perdarahan

Granulositopenia infeksi

Infiltrasi Organ

Expansi SST Nyeri sendi dan jaringan ikat

Lien Splenomegali

Hati Hepatomegali

nodus Limfatikus Limfadenopati

Susunan saraf pusat Gejala Neurologik

Mulut Gingival hipertropi, lesi oral


12/29

IDENTIFICATION OF THE DENTALPATIENT WITH A BLEEDINGDISORDER

review of the medical history

a family history

A patients past history of bleeding current medication with hemostatic

effect

Active medical conditions maypredispose to bleeding problems


13/29

Common manifestations ofleukemia

lymphadenopathy (71.4% in ALL; 45%in AML),

laryngeal pain (52.7% in ALL; 37.3%in AML),

gingival bleeding (43.2% in AML;

28.6% in ALL), oral ulceration, andgingival enlargement.

Fever (92.2%) all types of leukemia.


14/29

Oral manifestation ofleukemia

Gingival swelling andhemorrhage

Mucosal purpuraMucosal pallor Fungal and viral infections

Oral ulceration LymphadenopathyCytotoxic therapy can provoke

oral ulceration and mucositis


15/29

Oral manifestation in leukemia

spontaneous gingival hemorrhaging and small

petechial hemorrhages or bruising of the oral soft

tissue secondary to thrombocytopenia.

oral candidiasis, herpetic infections, and

neutropenic ulceration. These ulcers are typically

deep, punched-out lesions with a gray-white

necrotic base. They occur most commonly afterchemotherapeutics, related to mucosal trauma or

opportunistic infections.

Acute leukemias, particularly acute monocytic and

myelogenous subtypes, cause infiltration ofleukemic cells into oral soft tissue, especially

gingival tissue, resulting in swollen, hyperplastic

gingivitis


16/29


17/29
http://content.nejm.org/content/vol359/issue16/images/large/12f1.jpeg


18/29

Gingival hyperthrophy
http://content.nejm.org/content/vol359/issue16/images/large/12f1.jpeghttp://content.nejm.org/content/vol359/issue16/images/large/12f1.jpeg


19/29

Acute monocytic leukemia

Gingival Hyperplasia as an EarlyDiagnostic Oral Manifestation in

Acute Monocytic Leukemia


20/29

Gingival hyperplasia is most commonly

seen with the AML subtypes

acute monocytic leukemia (M5) (66.7%) acute myelomonocytic leukemia (M4)

(18.5%)

and acute myelocytic leukemia (M1,M2)(3.7%).

rapid gingival hyperplasia together with

gingival bleeding was the main reason of

the patient to seek therapy.


21/29

The oral cavity may be the

primary site of onset of

leukemia, so physicians anddentists should be aware of

these changes.


22/29

Pemeriksaan Laboratoriumpada Leukemia Akut

1. CBC/apus darah tepi.

2. Sitokimia

3. Immunologic marker


23/29

1. CBC/Apus darah tepi

Hb : menurun

Ringan sampai berat

Normochrom normocytic

Trombosit: menurun

Hitung leukosit:bervariasi

ADT : didapatkan sel muda,termasuk normoblas


24/29

Acute Myeloblastic Leukemia


25/29

Chronic Myeloid Leukemia


26/29

2. Cytochemistry

Pewarnaan khusus untuk mengidentifikasikomponen kimia sel (enzymes, lipids)

Termasuk :

Myeloperoxidase

Sudan Black B

Specific Esterase

Nonspecific Esterase

Periodeic Acid Schiff (PAS)


27/29

3. Immunologic MarkerStudies

Cell surface markers


28/29

Reference Book:

Denise M.Harmening

Clinical Hematology and Fundamentals

of Hemostasis, 4th edition, 2001

Anemia : pp 74-83

Leukemia : pp 272-300


29/29Thank You

leukemia fkg edit

Documents