Leucemia linfoide aguda a importancia do laboratorio de liquor para o sucesso do tratamento / Acute lymphoblastic leukemia: the importance of cerebrospinal fluid laboratory for successful treatament

RESUMO

A Leucemia Linfoide Aguda (LLA) e uma doenca caracterizada pelo acumulo de linfoblastos em numerosos orgaos e tecidos, notadamente na medula ossea. Entretanto as celulas malignas da LLA tem uma predisposicao de infiltrar o Sistema Nervoso Central (SNC) e os testiculos, sendo estes, considerados ¡°santuarios¡±. A importancia ao diagnostico da avaliacao citologica do liquido cefalorraqueano(Liquor) tornou-se fundamental para adequacao do tratamento, prognostico e para o monitoramento de eventuais recaidas. Citologicamente pode-se determinar um ¡°STATUS¡±, sendo que a avaliacao mais aceita atualmente ao diagnostico deve seguir os seguintes criterios Status 1 puncao nao traumatica com ausencia de blastos apos citocentrifugacao. Status 2 puncao nao traumatica com presenca de blastos apos citocentrifugacao e leucocitos ¡Ü5/mm3. Status 3 puncao nao traumatica com presenca de blastosapos citocentrifugacao e leucocitos ¡Ý5/mm3 . A puncao traumatica deve ser classificada como risco, pois pode haver a infiltracao na hora da puncao. O objetivo deste trabalho e definir criteriosamente a importancia da atuacao do Farmaceutico Bioquimico no Laboratorio de Liquor auxiliando o clinico na avaliacao de conduta terapeutica baseado na avaliacao citologica do liquido cefalorraqueano.

ABSTRACT

Acute Lymphoblastic Leukemia (ALL) is an illness characterized for the accumulation of blasts in numerous organ and tissue, essential in the blone marrow. However the malignant cells of the ALL have a predisposition to infiltrate central nervous system(CNS) and the testicules, being been these, considered "sanctuaries". The importance to the diagnosis of the cytological evaluation of the cerebrospinal fluid (CSF), became basic for adequacy of the treatment, prognostic and for the involvement of eventual fallen again. Cytologically a "STATUS" can be determined, being most accepted currently to the diagnosis must follow the following criteriaCNS1 (puncture nontraumatic without leukemic blasts after ytocentrifugation), CNS2 (puncture nontraumatic, ¡Ü5 WBC/mm3 CSF with identifiable blasts after cytocentrifugation), CNS3 (puncture nontraumatic, ¡Ý5 WBC/mm3 CSF with identifiable blasts aftercytocentrifugation). TLP(+) ¨C puncture traumatic with blasts, and TLP(-) ¨C puncture traumatic without blasts. The traumatic puncture must be classified as risk therefore it can have infiltration in the hour puncture. The objective of this work is reintensification to define the importance of the performance of the Pharmaceutical Biochemist in the Cerebrospinal Fluid Laboratory assisting the physician in the based evaluation of therapeutical behavior in the cytological evaluation of the Cerebrospinal Fluid.