11. Acute leukemia: types, etiology, pathogenesis, clinical manifestation, diagnosis, treatment. Flashcards
what causes AML ?
chemotherapy
radiation
bezene
secondary aml = poorprognosis
to mylodysplastic syndrome
aplastic anemia
myeloproliefrative syndrome
genetic :
down syndrome
and turner
sign and symptoms of AML ?
A lack of normal white blood cell production makes people more susceptible to infections
Thrombocytopenia
Epistaxis is defined as acute hemorrhage from the nostril
bleeding and petechiae
gingival involvement = in monocytic AML m4 / m5
bone and joint pain
anemia - weakness , tirendess , pallour
retinal hemorrhages
cns involvemnt = headache ,change in mental status
palsy
highest incidence in relapsed M4 and M5
dic = m3
diagnosis of AML ?
cbc
pancytopnea : anemia,
normocytic or macrocyic - due to rapd turnover
thrombocytopenia and granlocytopnea
tumor lysisi syndrome = hyperphosphatemia heprkalemia , hyperurecemia , HYPOKALCEMIA
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bone marrow biopsy
20% myeloid blasts
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blood smear :
Shows many immature blasts with only rare mature segmented granulocytes
romanowsky stain in bone marrow = see alot o the blast cells , and syplasia
esterase
TdT negative
myeloperoxidase stain positive = auer rods
for myeloblast
not monoblasts
sudan black stain
immunophenotyping
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real tme pcr = detects known translocation
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csf findings of blast cells
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flow cytometry
cd33 , 34 ,13
what is the treatment for AML ?
induction therapy = chemotherapy at high dose
cytarabine 7 days
3 days daunorubicin
10 days
consolidation therapy
After complete remission, 2
-3 cycles of the same drugs
maintencae therapy
monthy chemotherapy
hematopoiec stem cell transplant las resort used inpatents after 1st remission and poor porgnostic factors
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if m3 = give ATRA
ll trans retinoic acid
what is a complication of AML treatment ?
unfortunately not only kills the blasts but also prohibits
the normal haematopoiesis in the bone marrow, the patients basically gain an
aplastic bone marrow
immunoprophylaxis to prevent infections
ALL is more common in whom ?
in children - most coomon leukemia in children
new born to 14 years old
etiology of Acute LYMPHOBLASTIC leukemia
chemotherapy
radiation
benzene
trisomy 21
what is the diagnosis of ALL
pancytopnea
normocytic or macrocytic anemia = due to folic acid deficicny
tumor lysis syndrome
peripheral blood smear - the lymphoblasts have very little cytoplasm to nucleus , so scanty cytoplasm
less prominent nucleoli
NO GRANULES ]coarse chromatin
most than 20 percent of blast cells in bone marrow
positive for TdT marker
and MPO negative
esterase negative
flow cytometry for cd
PAS positive
what is the classification of ALL ?
pre - b cells
= trisomy 21 in child
= cd19, cd20
CALA cd10 (acutelymphoblastic leukemia antigen)
t9: 22 bad prognosisi
t12: 21 good prognosis
b cell = ALL
t cells ALL
mass in the mediastinum
cd3 positive
3,4,5,6,7,8
when do people hve acute myeloid leukema and what are the charteristics ?
in adults 40-60 years old
and abrupt
what is the classification of AML ?
m2 acute myeloblastic leukema
type is the most common
myeloblastic with maturation
t8 :21
m3 = acute promyelocytic leukemia
t15L17 good prognosis
assocaited with DIC
M3 we can treat it with VITAMIN A = ATRA all trans retnoic acid
m5 = monocytic with alot of gum ilfiltration
m4 = myelomonocytic leukrmia
what are the prognosisi of AML according to genetics ?
most common good porgnosis t8:21 m2
t15:17 = m3
inversion of 6
intermediate t 19:11
bad
inversion of 3
monomoy 7
5q deletion
what are the bad prognostic factors for aml ?
above 50
cytogenetics
treatmnet response mroe than 20 perce blasts in first curse
secondary amp
trilineage myelodysplasia
what are the sympotms of ALL
hepatosplenomegaly
neuropathies due to meningeal infiltration
anemia = weakness
pancytopnea :fever , infetions
bleeding
bone pain
what is bad prognosiis in all ?
more than 60
wbc over 100,000
philadelphia chromsome 9:22
