DIAGNOSTIC CHALLENGES IN ACUTE MONOBLASTIC /MONOCYTIC LEUKEMIA IN CHILDREN OF QUETTA BALUCHISTAN
Main Article Content
Keywords
Acute Monoblastic/Monocytic Leukemia (AMoL), Pediatric Leukemia Diagnosis, Diagnostic Challenges
Abstract
Background: Particularly in low-resource areas with poor pediatric healthcare facilities, such as Quetta, Baluchistan, acute monoblastic/monocytic leukemia (AMoL) poses special diagnostic challenges.
Objective: To investigate the difficulties in diagnosing AMoL in children, with an emphasis on clinical obstacles, laboratory shortcomings, and institutional constraints.
Methods: 100 people participated in the qualitative study, which included pediatric patients, caregivers, and medical professionals. Semi-structured interviews were used to gather the data, which were then subjected to thematic analysis.
Results: Financial difficulties, irregular cytochemical labeling, a shortage of qualified morphologists, and restricted access to flow cytometry and molecular testing were among the main obstacles. Misunderstandings and delays in diagnosis were frequent.
Conclusion: For quick and precise AMoL diagnosis in underprivileged pediatric populations, it is essential to improve infrastructure, training, and reasonably priced diagnostics.
References
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11. Peterson L, Dehner LP, Brunning RD. Extramedullary masses as presenting features of acute monoblastic leukemia. Am J Clin Pathol. (1981) 75:140 8. doi: 10.1093/ajcp/75.2.140
12. Font RL, Mackay B, Tang R. Acute monocytic leukemia recurring as bilateral perilimbal infiltrates. Immunohistochemical and ultrastructural confirmation. Ophthalmology. (1985) 92:1681–5. doi: 10.1016/S0161-6420(85)34091-5
13. Hertler AA, Rosenwasser GO, Gluck WL. Isolated anterior chamber relapse in acute monoblastic leukemia. Am J Hematol. (1986) 23:401 3. doi: 10.1002/ajh.2830230412
14. Krendel DA, Albright RE, Graham DG. Infiltrative polyneuropathy due to acute monoblastic leukemia in hematologic remission. Neurology. (1987) 37:474 7. doi: 10.1212/WNL.37.3.474
15. Peterson BA, Brunning RD, Bloomfield CD, Hurd DD, Gau JA, Peng GT, et al. Central nervous system involvement in acute nonlymphocytic leukemia. A prospective study of adults in remission. Am J Med. (1987) 83:464 70. doi: 10.1016/0002-9343(87)90756-X
16. Gottesfeld E, Silverman RA, Coccia PF, Jacobs G, Zaim MT. Transient blueberry muffin appearance of a newborn with congenital monoblastic leukemia. J AmAcadDermatol. (1989) 21:347–51. doi: 10.1016/S0190-9622(89)80032-5
17. Roberts JP, Atwell JD. Testicular enlargement as a presenting feature of monocytic leukemia in an infant. J Pediatr Surg. (1989) 24:1306–7. doi: 10.1016/S0022-3468(89)80573-1
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20. AugerMJ, MackieMJ,Aquantitativestudyofmonocyteprocoagulantactivity in acute monoblastic and chronic myelomonocytic leukaemias. Acta Haematol. (1987) 78:37–40. doi: 10.1159/000205833
21. Alvarenga B, Manzo E, Arca G, Higashi M, Mattos E, Melo I, et al. Disseminated intravascular coagulation and concomitant central nervous system bleeding in acute monoblastic leukemia: case report. Hematol Transfusion Cell Therapy. (2020) 42:308–9. doi: 10.1016/j.htct.2020.10.513
22. Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. (2009) 114:937–51. doi: 10.1182/blood-2009-03-209262
23. Dunphy CH. Comparative analysis of detecting monocytic cells and their aberrancy. Appl Immunohistochem Mol Morphol. (2011) 19:336–40. doi: 10.1097/PAI.0b013e3182052805
24. McKenna RW, Bloomfield CD, Dick F, Nesbit ME, Brunning RD. Acute monoblastic leukemia: diagnosis and treatment of ten cases. Blood. (1975) 46:481 94. doi: 10.1182/blood.V46.4.481.481
25. Brynes RK, Golomb HM, Desser RK, Recant W, Reese C, Rowley J. Acute monocytic leukemia. Cytologic, histologic, cytochemical, ultrastructural, and cytogenetic observations. Am J Clin Pathol. (1976) 65:471–82. doi: 10.1093/ajcp/65.4.471
26. Shaw MT, Nordquist RE. “Pure” monocytic or histiomonocytic leukemia: a revised concept. Cancer. (1975) 35:208–14.
27. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the acute leukaemias. French American–British (FAB) co-operative group. Br J Haematol. (1976) 33:451 8. doi: 10.1111/j.1365-2141.1976.tb03563.x
28. Goasguen JE, Bennett JM, Bain BJ, Vallespi T, Brunning R, Mufti GJ, et al. Morphological evaluation of monocytes and their precursors. Haematologica. (2009) 94:994–7. doi: 10.3324/haematol.2008.005421
29. Medeiros L, Miranda R. Diagnostic Pathology: Lymph Nodes and Extranodal Lymphomas- 2nd Edition. Elsevier Inc.: Amsterdam (2018)
30. Gupta AK, Meena JP, Chopra A, Tanwar P, Seth R. Juvenile myelomonocytic leukemia-A comprehensive review and recent advances in management. Am J Blood Res. (2021) 11:1–21.
31. Wrotnowski U, Innes DJ, Hobson AS. Nonspecific esterase staining patterns in acute monocytic leukemia. Am J Clin Pathol. (1987) 87:515 8. doi: 10.1093/ajcp/87.4.515
32. Sultan C, Imbert M, Ricard MF, Sebaoun G, Marquet M, Brun B, et al. Pure acute monocytic leukemia. A study of 12 cases. Am J Clin Pathol. (1977) 68:752–7. doi: 10.1093/ajcp/68.6.752
33. Sultan C, Imbert M, Ricard MF, Sebaoun G, Marquet M, Brun B, et al. Pure acute monocytic leukemia. A study of 12 cases. Am J Clin Pathol. (1977) 68:752–7. doi:10.1093/ajcp/68.6.752
34. Wrotnowski U, Innes DJ, Hobson AS. Nonspecific esterase staining patterns in acute monocytic leukemia. Am J Clin Pathol. (1987) 87:515–8. doi:10.1093/ajcp/87.4.515
35. Medeiros L, Miranda R. Diagnostic Pathology: Lymph Nodes and Extranodal Lymphomas-2nd Edition. Elsevier Inc.: Amsterdam (2018)
36. Goasguen JE, Bennett JM, Bain BJ, Vallespi T, Brunning R, Mufti GJ, et al. Morphological evaluation of monocytes and their precursors. Haematologica. (2009) 94:994–7. doi:10.3324/haematol.2008.005421
37. Gupta AK, Meena JP, Chopra A, Tanwar P, Seth R. Juvenile myelomonocytic leukemia – A comprehensive review and recent advances in management. Am J Blood Res. (2021) 11:1–21
38. Dunphy CH. Comparative analysis of detecting monocytic cells and their aberrancy. Appl Immunohistochem Mol Morphol. (2011) 19:336–40. doi:10.1097/PAI.0b013e3182052805
39. Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A, et al. The 2008 revision of the WHO classification of myeloid neoplasms and acute leukemia. Blood. (2009) 114:937–51. doi:10.1182/blood-2009-03-209262
40. Alvarenga B, Manzo E, Arca G, Higashi M, Mattos E, Melo I, et al. Disseminated intravascular coagulation and CNS bleeding in AMoL. Hematol Transfusion Cell Ther. (2020) 42:308–9. doi:10.1016/j.htct.2020.10.513
2. Webb DK, Harrison G, Stevens RF, Gibson BG, Hann IM, Wheatley K, et al. Relationships between age at diagnosis, clinical features, and outcome of therapy in children treated in the Medical Research Council AML 10 and 12 trials for acute myeloid leukemia. Blood. (2001) 98:1714–20. doi: 10.1182/blood.V98.6.1714
3. Pession A, Masetti R, Rizzari C, Putti MC, Casale F, Fagioli F, et al. Results of the AIEOP AML 2002/01 multicenter prospective trial for the treatment of children with acute myeloid leukemia. Blood. (2013) 122:170 8. doi: 10.1182/blood-2013-03-491621
4. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American–British cooperative group. Ann Intern Med. (1985) 103:620–5. doi: 10.7326/0003-4819-10 3-4-620.
5. Brunning RD, Matutes E, Flandrin G, Vardiman J. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press. (2001).
6. Hossfeld DK. Book reviews. World health organization classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. Ann Onc. (2002) 13:490–1. doi: 10.1093/annonc/m df146
7. Creutzig U, Ritter J, Budde M, Sutor A, Schellong G. Early deaths due to hemorrhage and leukostasis in childhood acute myelogenous leukemia. Associations with hyperleukocytosis and acute monocytic leukemia. Cancer. (1987) 60:3071–9.3.
8. 8. Porcu P, Cripe LD, Ng EW, Bhatia S, Danielson CM, Orazi A, et al. Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma. (2000) 39:1–18. doi: 10.3109/10428190009053534
9. 9. Schwonzen M, Kuehn N, Vetten B, Diehl V, Pfreundschuh M. Phenotyping of acute myelomonocytic (AMMOL) and monocytic leukemia (AMOL): association of T-cell-related antigens and skin-infiltration in AMOL. Leuk Res. (1989) 13:893 8. doi: 10.1016/0145-2126(89)90042-8.
10. Cuttner J, Conjalka MS, Reilly M, Goldberg J, Reisman A, Meyer RJ, et al. Association of monocytic leukemia in patients with extreme leukocytosis. Am J Med. (1980) 69:555–8. doi: 10.1016/0002-9343(80)90467-2
11. Peterson L, Dehner LP, Brunning RD. Extramedullary masses as presenting features of acute monoblastic leukemia. Am J Clin Pathol. (1981) 75:140 8. doi: 10.1093/ajcp/75.2.140
12. Font RL, Mackay B, Tang R. Acute monocytic leukemia recurring as bilateral perilimbal infiltrates. Immunohistochemical and ultrastructural confirmation. Ophthalmology. (1985) 92:1681–5. doi: 10.1016/S0161-6420(85)34091-5
13. Hertler AA, Rosenwasser GO, Gluck WL. Isolated anterior chamber relapse in acute monoblastic leukemia. Am J Hematol. (1986) 23:401 3. doi: 10.1002/ajh.2830230412
14. Krendel DA, Albright RE, Graham DG. Infiltrative polyneuropathy due to acute monoblastic leukemia in hematologic remission. Neurology. (1987) 37:474 7. doi: 10.1212/WNL.37.3.474
15. Peterson BA, Brunning RD, Bloomfield CD, Hurd DD, Gau JA, Peng GT, et al. Central nervous system involvement in acute nonlymphocytic leukemia. A prospective study of adults in remission. Am J Med. (1987) 83:464 70. doi: 10.1016/0002-9343(87)90756-X
16. Gottesfeld E, Silverman RA, Coccia PF, Jacobs G, Zaim MT. Transient blueberry muffin appearance of a newborn with congenital monoblastic leukemia. J AmAcadDermatol. (1989) 21:347–51. doi: 10.1016/S0190-9622(89)80032-5
17. Roberts JP, Atwell JD. Testicular enlargement as a presenting feature of monocytic leukemia in an infant. J Pediatr Surg. (1989) 24:1306–7. doi: 10.1016/S0022-3468(89)80573-1
18. Jones D, Dorfman DM, Barnhill RL, Granter SR. Leukemic vasculitis: a feature of leukemia cutis in some patients. Am J Clin Pathol. (1997) 107:637 42. doi: 10.1093/ajcp/107.6.637
19. 19. Bussel JB, Steinherz PG, Miller DR, Hilgartner MW, A. heparin-like anticoagulant in an 8-month-old boy with acute monoblastic leukemia. Am J Hematol. (1984) 16:83–90. doi: 10.1002/ajh.2830160111
20. AugerMJ, MackieMJ,Aquantitativestudyofmonocyteprocoagulantactivity in acute monoblastic and chronic myelomonocytic leukaemias. Acta Haematol. (1987) 78:37–40. doi: 10.1159/000205833
21. Alvarenga B, Manzo E, Arca G, Higashi M, Mattos E, Melo I, et al. Disseminated intravascular coagulation and concomitant central nervous system bleeding in acute monoblastic leukemia: case report. Hematol Transfusion Cell Therapy. (2020) 42:308–9. doi: 10.1016/j.htct.2020.10.513
22. Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A, et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. (2009) 114:937–51. doi: 10.1182/blood-2009-03-209262
23. Dunphy CH. Comparative analysis of detecting monocytic cells and their aberrancy. Appl Immunohistochem Mol Morphol. (2011) 19:336–40. doi: 10.1097/PAI.0b013e3182052805
24. McKenna RW, Bloomfield CD, Dick F, Nesbit ME, Brunning RD. Acute monoblastic leukemia: diagnosis and treatment of ten cases. Blood. (1975) 46:481 94. doi: 10.1182/blood.V46.4.481.481
25. Brynes RK, Golomb HM, Desser RK, Recant W, Reese C, Rowley J. Acute monocytic leukemia. Cytologic, histologic, cytochemical, ultrastructural, and cytogenetic observations. Am J Clin Pathol. (1976) 65:471–82. doi: 10.1093/ajcp/65.4.471
26. Shaw MT, Nordquist RE. “Pure” monocytic or histiomonocytic leukemia: a revised concept. Cancer. (1975) 35:208–14.
27. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the acute leukaemias. French American–British (FAB) co-operative group. Br J Haematol. (1976) 33:451 8. doi: 10.1111/j.1365-2141.1976.tb03563.x
28. Goasguen JE, Bennett JM, Bain BJ, Vallespi T, Brunning R, Mufti GJ, et al. Morphological evaluation of monocytes and their precursors. Haematologica. (2009) 94:994–7. doi: 10.3324/haematol.2008.005421
29. Medeiros L, Miranda R. Diagnostic Pathology: Lymph Nodes and Extranodal Lymphomas- 2nd Edition. Elsevier Inc.: Amsterdam (2018)
30. Gupta AK, Meena JP, Chopra A, Tanwar P, Seth R. Juvenile myelomonocytic leukemia-A comprehensive review and recent advances in management. Am J Blood Res. (2021) 11:1–21.
31. Wrotnowski U, Innes DJ, Hobson AS. Nonspecific esterase staining patterns in acute monocytic leukemia. Am J Clin Pathol. (1987) 87:515 8. doi: 10.1093/ajcp/87.4.515
32. Sultan C, Imbert M, Ricard MF, Sebaoun G, Marquet M, Brun B, et al. Pure acute monocytic leukemia. A study of 12 cases. Am J Clin Pathol. (1977) 68:752–7. doi: 10.1093/ajcp/68.6.752
33. Sultan C, Imbert M, Ricard MF, Sebaoun G, Marquet M, Brun B, et al. Pure acute monocytic leukemia. A study of 12 cases. Am J Clin Pathol. (1977) 68:752–7. doi:10.1093/ajcp/68.6.752
34. Wrotnowski U, Innes DJ, Hobson AS. Nonspecific esterase staining patterns in acute monocytic leukemia. Am J Clin Pathol. (1987) 87:515–8. doi:10.1093/ajcp/87.4.515
35. Medeiros L, Miranda R. Diagnostic Pathology: Lymph Nodes and Extranodal Lymphomas-2nd Edition. Elsevier Inc.: Amsterdam (2018)
36. Goasguen JE, Bennett JM, Bain BJ, Vallespi T, Brunning R, Mufti GJ, et al. Morphological evaluation of monocytes and their precursors. Haematologica. (2009) 94:994–7. doi:10.3324/haematol.2008.005421
37. Gupta AK, Meena JP, Chopra A, Tanwar P, Seth R. Juvenile myelomonocytic leukemia – A comprehensive review and recent advances in management. Am J Blood Res. (2021) 11:1–21
38. Dunphy CH. Comparative analysis of detecting monocytic cells and their aberrancy. Appl Immunohistochem Mol Morphol. (2011) 19:336–40. doi:10.1097/PAI.0b013e3182052805
39. Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A, et al. The 2008 revision of the WHO classification of myeloid neoplasms and acute leukemia. Blood. (2009) 114:937–51. doi:10.1182/blood-2009-03-209262
40. Alvarenga B, Manzo E, Arca G, Higashi M, Mattos E, Melo I, et al. Disseminated intravascular coagulation and CNS bleeding in AMoL. Hematol Transfusion Cell Ther. (2020) 42:308–9. doi:10.1016/j.htct.2020.10.513
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Apr 29, 2025
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Dr. Uzma Qudoos, Dr. Aamir Salam Lehri, Dr. Maryam Jalal, Prof. Dr. Shabir Ahmed Lehri, Dr. Samia Anjum, Dr. Goharam Manzoor, Dr. Muhammad Waseem, & Sana Ullah Kakar. (2025). DIAGNOSTIC CHALLENGES IN ACUTE MONOBLASTIC /MONOCYTIC LEUKEMIA IN CHILDREN OF QUETTA BALUCHISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 32(4), 1165-1171. https://doi.org/10.53555/q7hp8h40
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Author Biographies
Dr. Uzma Qudoos
Department of Medicine, Bolan Medical College Hospital, Quetta, Pakistan
Dr. Aamir Salam Lehri
MPH Trainee, Institute of Public Health, Quetta, Pakistan
Dr. Maryam Jalal
Resident, Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi,Pakistan
Prof. Dr. Shabir Ahmed Lehri
Vice-Chancellor, Balochistan University of Medical and Health Sciences (BUMHS), Quetta,Pakistan
Dr. Samia Anjum
Department of Medicine, Bolan Medical College Hospital, Quetta, Pakistan
Dr. Goharam Manzoor
Department of Medicine, Bolan Medical College Hospital, Quetta, Pakistan
Dr. Muhammad Waseem
Department of Medicine, Bolan Medical College Hospital, Quetta, Pakistan
Sana Ullah Kakar
Department of Psychiatry, Balochistan Institute of Psychiatry and Behavioural Sciences (BIPBS),Quetta, Pakistan
How to Cite
Dr. Uzma Qudoos, Dr. Aamir Salam Lehri, Dr. Maryam Jalal, Prof. Dr. Shabir Ahmed Lehri, Dr. Samia Anjum, Dr. Goharam Manzoor, Dr. Muhammad Waseem, & Sana Ullah Kakar. (2025). DIAGNOSTIC CHALLENGES IN ACUTE MONOBLASTIC /MONOCYTIC LEUKEMIA IN CHILDREN OF QUETTA BALUCHISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 32(4), 1165-1171. https://doi.org/10.53555/q7hp8h40