Heme #6: AML, ALL, CML, CLL, MM Flashcards
What do myeloid cells give rise to?
What do lymphoid cells give rise to?
Myeloid: RBCs
Lymphoid: Lymphocytes (WBCs) and natural killer cells
Acute Lymphocytic Leukemia
-MC childhood malignancy (peak is ages 2-5). Other risk factors are…
-Pathophysiology of this condition
-Symptoms as a result of
-RF: Boys, Down Syndrome, Ages 2-5
-Overpopulation of immature WBC’s (blasts) overtake normal hematopoeisis, resulting in pancytopenia
-Symptoms: fever and infections (leukopenia), bleeding from thrombocytopenia, petechiae, purpura, anemia, pallor, fatigue.
–CNS symptoms: stiff neck, visual changes, METs to CNS and testes MC.
–Hepatosplenomegaly, abdominal pain, LAD
What is the MC physical exam finding of ALL?
What should you remember to remember this condition?
-Hepatomegaly or splenomegaly
ALL my children. MC childhood malignancy.
Diagnostics for ALL
-CBC + peripheral smear
-Bone marrow aspiration
-What is the most accurate test to determine different types of leukemia?
-CBC: WBC 5,000 - 100,000, thrombocytopenia
-Bone marrow aspiration: hypercellular with > 20% blasts (DEFINITIVE)
-Flow cytometry test is the best way to distinguish subtypes of leukemia
ALL is/isn’t highly response to combination chemotherapy?
If the patient has CNS disease, what medication can be used as treatment?
It is highly responsive to combination chemotherapy!
-Intrathecal Methotrexate
What is tumor lysis syndrome?
-Remember, it is related to the leukemias.
-Emergency that occurs after treatment due to rapid tumor cell lysis after chemotherapy, resulting in potassium, phosphate, and nucleic acids into circulation
-Symptoms of tumor lysis syndrome
-Lab findings with tumor lysis syndrome
-Symptoms: muscle cramps, tetany, nausea, vomiting, lethargy, HF, kidney injury
-Hypocalcemia
-Hyperuricemia, hyperphosphatemia, hyperkalemia, and acute kidney injury
How do you treat tumor lysis syndrome?
How can you prevent tumor lysis syndrome with medication?
-Treat electrolyte abnormalities, IVF
-Rasburicase or Allopurinol (catalyzes uric acid to a stable compound)
Chronic Lymphocytic Leukemia (CLL) is
-The MC form of leukemia in adults
-Mature B cell clonal malignancy
-Risk Factors?
-Increasing age (70 years is median age)
-Male gender
CLL symptoms
-Usually asymptomatic
-Pancytopenia: anemia symptoms (pallor, fatigue MC, dyspnea), neutropenia (increased infections), and thrombocytopenia (mucocutaneous bleeding)
-Lymphadenopathy MC exam finding, Splenomegaly, skin lesions (leukemia cutis)
What is seen on CBC with peripheral smear for CLL?
What other unique lab finding?
-Absolute lymphocytosis: small, well-differentiated normal-appearing lymphocytes with scattered “smudge cells”
–Smudge cells: fragile B cells become crushed by cover slip during slide preparation
-Hypogammaglobulinemia: increased incidence of autoimmune hemolytic anemia.
Management for CLL
-Chemotherapy
-Allogeneic stem cell transplant curative
Acute Myeloid Leukemia (AML)
-MC acute leukemia in adults
-Pathophysiology
-MC subtype
-Patho: accumulation of leukemia blasts (immature WBCs) in the bone marrow –> pancytopenia
-Acute promyelotic leukemia (APL or M3): associated with DIC, presence of Auer rods, and myeloperoxidase positivity
Symptoms of AML
-Pancytopenia: anemia (general fatigue MC initial symptom), thrombocytopenia (bleeding), neutropenia (infections)
What is seen on
-CBC with peripheral smear:
-Bone marrow biopsy (GOLD STANDARD):
-Immunophenotyping:
For AML
-CBC (best initial test): normocytic normochromic anemia. Thrombocytopenia. Circulating myeloblasts.
-Bone marrow biopsy (GOLD): >20% myeloblasts. Auer Rods (pink/red rods in cytoplasm) with APL.
-Immunophenotyping: Myeloperoxidase positivity with APL.