For unexpected bleeding from any part of the body, in a child/adult, like oozing of blood from the gums, haemorrhagic spots/areas on the skin, or excessive bleeding from the nose, say, after a blow, or profuse bleeding following tooth extraction or minor injury, the possibility of early acute leukaemia must be considered for precise diagnosis. It is important to point out that leukaemias should be given due consideration and all efforts must be made to treat and control the condition.

Chronic leukaemia As compared to acute leukaemia, chronic leukaemia usually manifests itself at a later age, say at the age of 30-50 years, and has a different presentation from acute leukaemia. The disease remains hidden and the patient reports after months/years of the onset of the ailment, and in some cases it may be diagnosed accidentally during a routine medical check-up.

However, the disease can be diagnosed in infancy, and besides a clinical examination/ suspicion by the physician who may happen to examine the case, we need the expertise of a clinical pathologist/laboratory technician competent to spot out such cases from the routine tests like total leucocyte count (TLC), differential leucocyte count (OLC) and, above all, from the examination of the peripheral blood film (PBF), especially for immature cells, etc.

Enlargement of the spleen and/or glands of the body (prominently cervical), tenderness on the sternum, i.e., the bone lying in front of the middle of the chest (so-called sternal tenderness), may be considered some of the relatively / moderately early symptoms/signs.

Both in acute and chronic cases of leukaemia, a bone marrow examination and some other special tests are 'a must' to confirm the diagnosis.

Recovery in the case of leukaemia, whether acute or chronic, depends on the age of the patient, and on the type/ variety of the leukaemia diagnosed finally. There should be no unnecessary panic when the possibility of leukaemia is being considered. Many cases go well with their disease for several years before they begin to show. A middle-aged case of chronic leukaemia with some unusual complaints/symptoms detected for the first time by the author has still been continuing rather satisfactorily for the last ten years or so. He has retired from his job after completion of his tenure and has been living a fairly normal life. The idea of writing this is that the leukaemia patient or his family members should never go away with the idea that mortality is the rule in all such cases, as we see in some of the Indian movies.

However, it is very important to mention that a very scientific approach is required for the treatment of such cases. The patient needs the thorough guidance of the physician in respect of diet, exertion, stress, etc. He should undergo periodic check-ups, and blood-tests should be repeated, as advised. Above all, only the prescribed drugs should be taken by such patients. We lost one of our patients who on his own had shifted to other drugs, in spite of the fact that the prognosis of the case was rather good, and this fact was also confirmed by the late Dr. M.M. Wintrobe, a noted haematologist in the USA, who had also authored the book, Clinical Hematology (Lea & Febiger, Philadelphia), and to whom the detailed clinical data of the case were sent for a thorough probe/investigation. Later the peripheral blood films of this case were also taken to the USA for discussion by the author.

Interestingly, the patient also got carried away when some unauthentic approach for his treatment was suggested to him, but it came to the notice of the author in time, and he, to substantiate his views/line of action, sent the case to the Tata Memorial Hospital, Mumbai, which probably saved the patient from the likely tragedy. The patient referred to above, is at present progressing satisfactorily with his disease by following instructions as well as the treatment religiously.

Finally, it may be stressed that a great realization is required among the masses regarding blood cancers, but somehow, leukaemias are lagging far behind in cancer awareness campaigns / programmes.