Clinical, Morphological and Immunophenotypical Findings in Acute Leukemia: A Study from a Tertiary Care Hospital

Background: Acute leukemias comprise a heterogeneous group of diseases characterized by rapid and uncontrolled clonal expansion of progenitor cells of the hematopoietic system. Immunophenotyping helps subclassify acute leukemias into subgroups with prognostic implications. Materials and Methods: This descriptive observational cross-sectional study was performed on 80 newly diagnosed cases of acute leukemia in children up to 18 years of age from August 2012 to Febuary 2014. The immunophenotypic analysis was performed by Beckman Coulter Flow cytometer using monoclonal antibodies against various cell surface / cytoplasmic antigens. Results: Out of 80 cases, 68 cases had acute lymphocytic leukemia (ALL) and 12 cases had acute myelocytic leukemia (AML). In this study, 68 cases of ALL could be categorized into 53 cases of B-ALL, 13 of T-ALL, and 2 cases of Bi-phenotypic acute leukemia (BAL). Twelve cases of AML comprised of 7 cases of AML with minimal differentiation; 2 of AML with cases of AML with maturation, and 3 cases of acute myelomonocytic leukemia. Hepatosplenomegaly was seen in the majority of cases in both ALL and AML. Most cases had a total leucocyte count between 10,000 and 50,000/µl and platelets <100,000/µl.  Hemoglobin levels were < 7.5 g/dl in the majority of them. CD19 and CD79a were 100 % sensitive for B ALL, while cCD3 was 100% sensitive for T-ALL. MPO was positive in all cases of AML. Conclusion: Immunophenotyping must be done in all AL cases as it helps in risk-stratification and follow up of patients for evaluating minimal residual disease.