Adult Leukemias Flashcards Preview

Adult and Ped Test 7 > Adult Leukemias > Flashcards

Flashcards in Adult Leukemias Deck (31):
1

What is leukemia?

leukemia is when there is an abnormality in the blood cells that causes either uncontrollable

2

What is ALL

ALL is the most common leukemia in children age 3-7 years old. 20% of the time it is in adults CAUSE IS UKNOWN BUT THOUGHT... It is due to genetic changes to tumor suppressor genes or environmental exposures.

3

What is the pathogenesis of ALL

some type of damage occurs so that maturation STOPS at the lymphoblast cell. Lymphoblasts then crowd out space in the bone marrow, and depress for the formation of all other cells.

4

How does ALL present?

patient will be ACUTELY ill. Ill for several days to weeks.
1. BLEEDING on skin and mucosal surfaces
2. echymoses, purapura, petechiae
3. PALLOR
4. epistaxis or menorrhagia
5. FATIGUE and DYSPNEA to due to developed ANEMIA
6. INFECTIONS are often due to neutropenia
7. usually see a FEVER

in EXTREME CASES you see CNS confusion.

5

What will PE exam reveal for ALL?

bruising, BONE TENDERNESS, maybe enlargement of the spleen.

6

What will LABS for show ALL

cbc w/diff: LYMPHOBLASTS!!!!!! and pancytopenia.
WBC can LOOK increased due to increased number of blasts. BLASTS MUST BE GREATER THAN 20%.

Flow cytometry: CD19, CD10...mostly will be B cell lineage...
T cell = BAD!

7

What cytogenetics are unfavorable for ALL?

philadelphia chromosome!!!!

8

How should ALL be handled?

EMERGENCY!!!!

9

ALL treatment:

combo of chemo, which produced remission in about 90% of patients.

Patients with philadelphia chromosome should have a tyrosine kinase inhibitor!!!

10

Do ALL and AML present the same way?

YES

11

Describe AML

genetic changes due to tumor supressor genes or environmental exposure to chemo or radiation...but also is unknown.

12

What is the pathogenesis of AML

there is an ARREST development at the MYELOBLASTS!! they proliferate in the bone marrow and crowd out other cells.

13

Is AML common?

yes, it is the most common adult leukemia.

14

How does AML present?

patient will be ACUTELY ill. Ill for several days to weeks.
1. BLEEDING on skin and mucosal surfaces
2. echymoses, purapura, petechiae
3. PALLOR
4. epistaxis or menorrhagia
5. FATIGUE and DYSPNEA to due to developed ANEMIA
6. INFECTIONS are often due to neutropenia
7. usually see a FEVER

in EXTREME CASES you see CNS confusion.

15

What will you see on physical exam for AML?

bruising, BONE TENDERNESS, maybe enlargement of the spleen.

16

What will labs show you in AML?

cbc w/diff: MYELOBLASTS, pancytopenia
anemia
AURER RODS!!!!!!
flow cytometry: CD13 and CD 33

17

What is unfavorable to isolate in AML

5q or 7q, MLL gene or a WBC count over 100K

18

How should AML be approached?

EMERGENT!!!

19

What is the treatment for AML?

chemo.
once in remission then do a allogenic stem cell transplant.

20

What are the two most common sites for extra medullary leukemia?

CNS and testes

21

Describe AML-3 or APL?

It is a type of AML.
T (15:17), results in a fusion transcription gene.
The MOST CURABLE AML!!

22

Are acute leukemias curable?

YES

23

What is CLL?

a monoclonal disorder characterized by progressive accumulation of functionally incompetent lymphocytes. 90% are older than 50. Median age is 70. AN OLD PERSON DISEASE. ALL IS A YOUNG PERSON DISEASE.

24

How does CLL present?

asymptomatic most of the time.
Fatigue
Lymphadenoapthy
splenomegaly
hepatomegaly

25

What are the lab findings with CLL?

cbc w/diff: lymphocytosis (these cells are well-differentiated though!!!!) >20,000.
hypogammaglobinemia
PLT counts are typically normal, but if they aren't it is associated with a worse prognosis.
Cytogenenics: 14q, 13q, and 11q = BAD

26

What is the treatment for CLL?

MOST PAITENTS DO NOT REQUIRE TREATMENT!
However, if they DO...you need to give them immunoglobin every month to help fight infections along with chemo.

27

What is CML?

increase proliferation of the granulocytic cell line. Accounts for 20% of all leukemia.

28

What are the 3 phases of CML?

chronic - fatigue, weight loss, low grade fever, sweating, splenomegaly, decreased food intake due to enlargement of spleen.

Accelerated: bleeding, brusing

blast: bone pain and fever, this phase can progress to a blast crisis...acute myeloid leukemia.

29

What is a blast crisis

a blast crisis::

increasing anemia, thrombocytopenia, basophilia, rapidly enlarging spleen.

30

What the labs show with CML?

cvc with diff : increased wbc
elevated granulocytes
PLT counts vary
Philadelphia chromosome = BAD, and seen in 95%
bar/abl gene is detected by PCR

31

What is the treatment for CML

1. TK1 bc of philadelphia chromosome
2. chemo and TK1
3. transplant.