Clinically, this is a parallel condition to myelogenous leucemia,
except that the hyperplasia of cells occurs in lymphoid tissue, and
leads to an enormous over-production of lymphocytes rather than
myelocytes. It is more readily divided into acute and chronic forms
than myelogenous leucemia from differences in symptomatology.
In the =acute form=, adolescents are usually affected, the condition
beginning with tumefaction of the lymph glands, first noted in the
cervical region, but usually a general involvement. Dyspnea results
from pressure upon trachea and bronchi by the enlarged glands of the
mediastinum. There is pyrexia of 103 to 105 degrees, intermittent in
character.
The pressure upon nerve trunks and plexuses in the thorax leads to
variable anginas distributed not only in regions actually imposed upon
but over all sorts of possible reflex paths. The blood vessels of the
skin are easily broken down so that slight injuries result in great
suggillation. The patient rapidly develops anemia, and later goes into
a syndrome similar to the cachexia of malignancy. In fact, the rapid
termination and clinical course of acute lymphatic leukemia is parallel
to the action of malignancy. Probably the condition will eventually be
properly classified as a neoplasm of the blood itself.
The =chronic form= occurs in later life, and, instead of being an
abrupt rapid process, is slow, progressive and painless. It has the
lymph gland hyperplasia, but the enlargement is so gradual that
compensation is established to a remarkable degree. It is usually a
generalized process, first noted in the cervical and axillary glands
because of their accessibility. Usually both the spleen and liver are
enlarged, but this also is a slow and later development.
There may be exacerbations of temperature, but they are not constant or
usually severe. Hemorrhages into the skin are not common, but pruritus
may be very troublesome.
The patient comes to a physician because of symptoms resulting from his
secondary anemia, dyspnea, dyspepsia, and palpitation.
The =diagnosis= cannot be made without the aid of a blood study.
The blood picture shows a severe anemia with both the number of
erythrocytes and the hemoglobin percentage very much lowered. Of the
two findings, the hemoglobin percentage is relatively more decreased,
so that the color index is markedly lowered.
In the acute form nucleated reds are common. Just before death these
may show various forms and sizes as well as the normoblasts. In the
chronic form normoblasts do not appear except as the case grows
decidedly worse. As compared to myelogenous leucemia the anemia of
lymphatic leukemia is of greater severity.
In the leucocyte count there is great increase in numbers, the greater
part being composed of the lymphocytes. The lymphocytes may be either
of the large or small variety, and occasionally are found in about
equal proportions. In contra-distinction to the myelogenous type, the
increased type of cells are of the mononuclear nongranular types. It is
not very unusual to find a well advanced case of lymphatic leucemia
without abnormal cells in the blood count, the expression of pathology
being in the shape of disturbance in number and proportion of cells
rather than in development of abnormal types. The actual number of
leucocytes does not go as high in proportion to the gravity of the
condition in lymphatic leukemia as it does in the myelogenous. In other
words, a patient with lymphoid leucemia showing a count of 90,000
leucocytes with 90% of these lymphocytes is a much sicker man than the
myelogenous case showing a 350,000 leucocyte count.
Usually there is an actual as well as relative decrease of all the
granular types of leucocytes with the polymorphonuclear neutrophiles
especially decreased.
The =treatment= is systemic and symptomatic. Recovery is not to be
expected, but these unfortunates can be made relatively comfortable and
given occasional respite by judicious osteopathic care.