Acute Leukemia- P Flashcards
(25 cards)
What is leukemia and what is needed for the definition of acute?
Lymphoid or myeloid neoplasms with widespread involvement of bone marrow. Tumor cells are usually found in the blood
- >20% blasts for the Dx of Acute Leukemia
Increased blast cells take up space and Crowd out other areas of the BM causing what?
- Erythrocytopenia = Anemia- fatigue
- Thrombocytopenia- bleeding
- Neutropenia- infection
What do blast cells look like and what do they do the WBC?
Large, immature cells with punch out nucleoli.
Lacking cytoplasm
- Usually enter blood and increase WBC
Acute leukemias can be broken down into divisions and those divisions subdivided. name them.
- ALL- Acute lymphoid leukemia
a. B-ALL
b. T-ALL - AML- Acute myeloid Leukemia
a. Acute Promyelocytic leukemia
b. Acute Monocytic Leukemia
c. Acute Megakaryoblastic leukemia
What is Acute lymphoid leukemia? how can it be identified?
Neoplastic accumulation of lymphoblasts (>20%) in the BM
- TdT= Key marker of lymphBLASTS, found in the nucleus
What is TdT and where is it absent?
DNA polymerase
- absent in myeloid blasts and mature lymphocytes
ALL most likely presents in what age group. What individual is susceptible to this dz?
Mostly commonly in children
- Ass with Down syndrome (this would however present after the age of 5)
- if found in Adults it has a bad prognosis
CD10, CD19, CD20 and a TdT + lymphoblasts is indication of what?
B-ALL subdivision
CD10+ is most valuable cell marker
What is the prognosis of B-ALL and what determines this?
Excellent response to chemo (most responsive)
- however may spread to testes or brain (needs separate therapy for this due to BBB and TBB)
- Prognosis based off a cytogenetic abnormalities
What are the cytogenetic abnormalities related to B-ALL and what are their prognosis’s?
t(12,21) good prognosis found commonly in kids
t(9,22) poor prognosis found in adults
What is t(9,22) translocation also called and what dx process is it also seen?
Philadelphia chromosome
- Seen in CML more commonly
What cell markers does T-ALL express?
TdT+ lymphoblasts
- CD2-CD8
T-ALL usually presents in what Age group and with what types of symptoms?
Teenagers
- SVC (superior vena cava like symptoms)
- Due to Mediastinal (thymic) mass
What is the correct way to call a T-ALL?
Acute lymphoblastic lymphoma
- Due to mass in the thymus
What is acute myeloid leukemia? and how do you know they are myeloids?
neoplastic accumulating of immature myeloid cells (>20%) in the bone marrow
- they are characterized by a cytoplasmic staining for Myeloperoxidase (MPO)
What is one distinguishing factor of Myeloid cells that differs from all other cells?
Auer Rods- which are crystal aggregates of MPO
What age group is AML most common?
Adults from 50-60 years old
What are 3 ways to subclass AML?
- Cytogenetic abnormalities
- Linage of immature myeloid cells
- Surface markers
Patient shows up having been experiencing fevers, nigh sweats, chills malaise and weight loss. After exam you notice petechia in mouth. You do a work up and its hows anemia, thrombocytopenia and neutropenia. Cytogenetics show t(15:17). Is this a medical emergency? Whats the treatment? Whats the dx?
yes this is a medical emergency.
- Treat with Trans retinoic acid (ATRA)
- Acute promyeloocytic leukemia (APL)
What is the significant of the 15:17 translocation in APL?
It disrupts the retinoic acid receptor which leads to blocking maturation of promyelocytes. Which then build up
What cause the petechia?
DIC from the granules of the promyelocytes being released
ATRA is the treatment for APL how does this work?
Lets the promyelocytes mature and eventually die.
- keeps you healthy enough to receive other treatment as you could die from DIC in hours
What is acute monocytic leukemia? and what is it clinical pearl?
Proliferation of monoblasts–> usually LACK MPO
- usually infiltrate the gums= inflammation
What is acute megakaryoblastic leukemia?
Proliferation of Megakaryocytes which also lack MPO
- ass. with down syndrome and presents after the age of 5
