Hyperplastic syndrome: symptoms, diagnosis, treatment

Acute leukemia is a malignant disease with damage to the bone marrow, the organ of hematopoiesis. An anomaly is manifested in a bone marrow stem cell mutation and the appearance of immature lymphoid cells called lymphoblasts. In the blood there is a decrease in platelets, white blood cells and red blood cells. With the progression of the disease, unripe cells enter other organs and tissues. There is leukemic infiltration of lymph nodes, mucous membranes, spleen, liver, brain, etc. Leukemia, in which hyperplastic syndrome most often occurs, mainly children from two to five years old. According to statistics, the incidence in boys is higher than in girls. Adult illness affects more after 60 years.

Clinical syndromes

Various anomalies of the hematopoietic system in the body of an individual are manifested by various symptoms and syndromes. In some cases, it is impossible to separate the main and secondary complaints of the patient, therefore, in hematological patients it is reasonable to talk about a group of signs of common origin or syndromes instead of symptoms:

• hyperplastic;
• anemic;
• hemorrhagic;
• infectious toxic.

Causes of Leukemia

One of the priorities of medical science is the study of problems associated with leukemia. However, despite the ongoing research, scientists still have not identified the exact causes of leukemia. Only factors contributing to its development are identified. These include:

• Hereditary predisposition. Statistics show that close relatives in several generations suffer from leukemia.
• Exposure to carcinogens. Toxic substances: insecticides, fertilizers, oil products, as well as some medications (antibiotics of the penicillin group and cephalosporins) adversely affect the body of the individual.
• Infectious and viral diseases sometimes cause a mutation in healthy cells, and symptoms of acute leukemia in an adult can suddenly occur.
• The presence of chromosomal pathologies.
• Radiation exposure that causes abnormal degeneration of healthy cells.
• Severe congenital pathologies: Wiskott-Aldrich syndrome, Down.
• Chemotherapy. Holding it to treat other diseases in some cases provokes the development of leukemia.
• Systematic smoking.

These factors only contribute to the onset of the disease, but the disease develops even in their absence.

Clinical Signs of Leukemia

Common symptoms of acute leukemia in adults:

• Intoxication syndrome. It is characterized by general malaise, weakness, weight loss, and fever. The latter can occur with the presence in the body of a viral, bacterial or fungal infection.
• Hemorrhagic syndrome. There are hemorrhages on the dermis and mucous membranes, vomiting with blood and tarry stools.
• Hyperplastic syndrome. All lymph nodes that are available for examination and palpation are enlarged. They become dense, mobile, but painless even at high magnification. The spleen and liver become inflamed and increase in size, pain in the stomach occurs. As a result of the infiltration of the joint capsule and periosteum, as well as a bone marrow tumor, pain and aches in the bones appear.
• Anemic syndrome. As a result of intoxication, the skin becomes pale, bluish-red plaques appear, with slight damage to the dermis, panaritiums and paronychia appear, ulcerative necrotic changes in the oral cavity appear, and tachycardia is tormented.
• Respiratory disorders An increase in the lymph nodes of the mediastinum leads to compression of the bronchi and respiratory failure.
• Changes in the organs of vision. Edema of the optic nerve occurs, hemorrhage in the retina appears, leukemic plaques in the fundus are possible.

Leukemia Diagnosis

To make a diagnosis:

• to collect a complete medical history;
• examine the patient, make a palpation of the lymph nodes, liver and spleen;
• general blood test - the number of platelets, red blood cells and white blood cells is determined, abnormally changed blood cells are detected;
• chest x-ray - determine the increase in peripheral lymph nodes in the chest cavity, changes in the thymus gland and lung condition;
• bone marrow aspiration and biopsy;
• microscopic examination to determine malignant cells;
• spinal puncture - the presence of cancer cells is determined;
• CT - on the computer screen view the status of internal organs;
• MRI - allows you to get images of organs and tissues;
• Ultrasound - an ultrasound scan is performed to confirm an increase in the liver and spleen.

Based on a comprehensive examination, a diagnosis is made and treatment of the patient is prescribed.

Stages of the disease

There are three stages of the course of leukemia:

1. Initial - signs of leukemia are weak. They manifest in mild fatigue and drowsiness. The disease is discovered accidentally during preventive examinations or the diagnosis of other diseases that begin to worsen during this period. The main blood counts in a laboratory study can be slightly changed, the size of the liver is normal.
2. Expanded - various organs are affected, so the symptoms are pronounced. During this period, an alternation of exacerbations and remission occurs. Leukemia ends in recovery or a significant deterioration in all indicators.
3. Terminal - treatment turned out to be ineffective, the hematopoietic system is very depressed, ulcerative and necrotic changes occur. The stage ends with the death of the patient.

Leukemia in babies

Acute leukemia in children occurs and develops very quickly. The number of lymphoblasts increases rapidly, which affects the well-being of the child. He becomes lethargic, complains of nausea and headaches. In the evening, the temperature rises to 38 degrees and above, although no symptoms of a cold are observed. When bathing, parents can notice the appearance of bruises and bruises on the body. This symptom should alert if the baby does not fall during the game. Signs of the disease are expressed by exacerbations of chronic diseases or a long course of diseases such as pneumonia, bronchitis, pharyngitis, tonsillitis. They are difficult to treat, the child is forced to take medications for a long period, undermining the strength of an already weakened body. In addition, hyperplastic syndrome manifests itself in acute leukemia, expressed by a rapid increase in lymph nodes.

At the onset of the disease, the cervical ones are more often inflamed, then the submandibular, supraclavicular and axillary are involved. Lymph nodes increase all the time, but do not have soreness, and over time they can cause compression of the bronchi, superior vena cava, bile duct. Also, an increase in the size of organs such as the spleen and liver, which are easily palpated during palpation and protrude from the ribs, is rapidly occurring. Sometimes children experience gastric, rectal and nasal prolonged and volume bleeding. Most often, acute leukemia occurs in children, so parents need to be very attentive to the health status of the child and pay attention to all his ailments and complaints.

Treatment of the disease in children

When confirming the child’s leukemia, they are hospitalized in the hematological or oncological department of a specialized clinic. As a result of treatment, it is necessary:

• destroy damaged cells;
• carry out maintenance therapy;
• prevent the occurrence of infectious diseases;
• make up for the lack of platelets and red blood cells.

The duration of treatment in a hospital for each child is determined individually and consists of:

• chemotherapy - various combinations of cytostatic drugs are used;
• radiation therapy - selected for a specific patient;
• bone marrow transplantation - possible after high-dose drug therapy.

The tactics of treatment are determined by:

• the number of blast cells;
• the possibility of relapse;
• stage of the disease.

There are international recommendations (protocols) for the treatment of leukemia. For the treatment of the child, a long program is drawn up according to the protocol with a clear prognosis of survival, the intensity of the course is directly dependent on the risk of relapse. Without bone marrow transplantation, treatment for leukemia lasts about two years. During this period, inpatient treatment is replaced several times by outpatient treatment.

Therapy stages

According to international recommendations, the treatment of childhood leukemia consists of the following steps:

• Preliminary - during this period, the patient is prepared for the main course. To do this, a short course of chemotherapy is done to reduce the number of leukemia cells and prevent kidney failure.
• Inductive - carried out for the onset of remission. Used therapy, enhanced by several drugs and lasting from one and a half to two months.
• Consolidation time with intensive care - the achieved remission is fixed when the normal sizes of the liver are established and the lymph nodes are reduced. The development of a tumor on the brain and spinal cord is prevented. During this period, if necessary, irradiation is applied and cytostatics are introduced into the canal of the spinal cord.
• Repeated combination - various combinations of potent drugs are administered, conducting separate courses. The period can last up to several months. The goal is to destroy blast cells.
• Maintenance therapy - performed on an outpatient basis. A child can attend kindergarten or school. The dosage of drugs is minimized.

The use of protocols helps to increase the effectiveness of treatment; experience is accumulated in the prevention of complications and the identification of side effects of drugs.

Differential diagnosis of hyperplastic syndrome

The manifestations of this syndrome should be differentiated from:

• Vincent's necrotizing stomatitis;
• hypertrophic gingivitis of another etiology;
• reactions in severe infections of a bacterial nature;
• infectious mononucleosis;
• heavy metal poisoning;
• hypovitaminosis C.

In all these cases, there are no leukemia markers in the blood test and myelogram. In doubtful situations, a bone marrow examination is performed, in some cases multizonal, when a substance from three points is taken for analysis.

Adult Leukemia Treatments

After the diagnosis, treatment begins immediately, which is carried out in oncological hematology centers according to the established prescription schemes. The main task is to restore healthy blood formation, prolonged remission, and prevention of relapse. To select a treatment regimen, the patient's age, his individual characteristics and the number of white bodies in the blood are taken into account. The main treatment methods consist of:

• Chemotherapy - combined cytostatic drugs are administered intravenously. Therapy is carried out in courses, taking into account the weight of the patient and the level of blood mutation. A new type of chemotherapy is used with the preparations Imatinib and Herceptin, which inhibit the growth of unhealthy cells.
• Biological intake - use drugs to maintain the defenses of the patient's body and reduce hyperplastic syndrome.
• Radiation method - use the effect of radiotherapy on the bone marrow under the control of CT.
• Surgical route - bone marrow transplantation is prescribed during remission of the disease. Preliminary chemotherapy and irradiation of the damaged area. This method is considered very effective and is carried out with a complete remission of the disease.

Leukemia prognosis

The forecast is influenced by the following factors:

• type of leukemia;
• patient age;
• features of the disease;
• individual response to chemotherapy.

Children with leukemia have a significantly better prognosis than adults. This is due to the fact that the drugs used for treatment in children cause fewer adverse reactions. In addition, the elderly have many concomitant diseases that do not allow for full chemotherapy. And adults in most cases go to the doctor with an advanced form of the disease, when leukemia hyperplasia is pronounced. According to medical statistics, five-year survival in acute leukemia in children is up to 85%, and in adults - only up to 40%. This is a serious but treatable disease. Modern treatment protocols provide high efficacy. It should be noted that after a five-year remission, relapses of the disease never occur.

Conclusion

Acute leukemia is a rapidly progressive form of cancer of the hematopoietic bone marrow tissue. A stem cell mutation occurs that spreads throughout the body, causing symptoms of the disease. Healthy cells begin to be replaced by altered ones, and this is accompanied by severe consequences.

At the same time, the production of healthy cells decreases, since the presence of a tumor promotes the synthesis of substances that inhibit their growth. This pathology occurs with damage to the bone marrow, spleen, liver, thymus and peripheral lymph nodes.