- PML + RARa next to each other - Need to give them RA that it will like - has tissue factor and annexin on surface of cells

WBC : normal is 4-11 1. 20-30 2. Over 50

1. Infection, autoimmune, stress 2. Leukemia (C-diph rip roaring infection)

Dr. Pence - Leukemia And Lymphoma Case Studies Flashcards by Radhika Patel

66yo males comes in with anemia for 2 years 
Dx him with MDS which is ?
Comes in with fever, tachy, HTN, petechiae, conjunctiva pallor bilaterally, bruising 
- low WBC
- low plt
- low hct
- low hgb
BS : 25% blasts, large nuclei 
= what is it and how to confirm

MDS : macrocytic anemia, pre-leukemic (only anemia sx)

AML , confirm with flow cytometry

How well did you know this?

Not at all

Perfectly

MDS is what

Happens usually after 70yo, genetic mutation causes damage to hematopoietic cells = no hematopoiesis

macrocytic
pre-leukemic

How well did you know this?

Not at all

Perfectly

ANC is what what does it mean

Absolute N count = (WBC) (N% + Band%)

Neutropenia = ANC < 1,500, severe Neutropenia = < 500

How well did you know this?

Not at all

Perfectly

How to TX AML and neutropenic fever

Get urine (1) and blood culture (2 different sites)
CXR (for pneumonia)
Begin ABs
Confirm AML confirmed by BM biopsy
Begin chemotherapy (treat AML), 2 weeks

How well did you know this?

Not at all

Perfectly

What are them most common infection to get for a neutropenic fever
What is the most severe infection you can get

Gram + staph or strep

2. Gram - pseudomonas,

How well did you know this?

Not at all

Perfectly

How to TX for neutropenic fever

Cefepime, Piperacillin-tazobactam, Meropenem, Ceftazidine (covers pseudomonas and gram +)
Is line infection of soft tissue infection (think MRSA) and add Vancomycin
If still not removed : it’s probably fungal so add anti-fungal (Amphotericin B, Voriconazole)

How well did you know this?

Not at all

Perfectly

How to confirm AML

BM biopsy of at least 20% blasts

How well did you know this?

Not at all

Perfectly

How to administer chemotherapy

Central line with 2 catheters and into the SVC that’s next to the RA + with abs

How well did you know this?

Not at all

Perfectly

While on chemo for a while pt is still having a fever and you see the pt has a fungal
What do I need to do

Remove central line and replace it (since fungal is sticky) and then you give them anti-fungal + CSF(nupogen)

How well did you know this?

Not at all

Perfectly

How to dx gram -, gram + fungal

Gram - : pink
Gram + : purple
Fungal : Silver stain

How well did you know this?

Not at all

Perfectly

Induction
Consolidation
Maintenance
Meaning is chemotherapy

chemotherapy given to get to remission
intensified chemotherapy to make sure no cancer cells are left
long term therapy or drug to prevent relapse (Stem cell transplant is only successful in younger populations and 20% of the time)

How well did you know this?

Not at all

Perfectly

ALL is common in what populations

Children

How well did you know this?

Not at all

Perfectly

ALL SX

Fatigue, anemia, bleeding, infection, cytopenia,
+ LYMPHADENOPATHY + SPLENOMEGALY (not seen in AML)
+ at least 20% Lymphoblastic found in BM

How well did you know this?

Not at all

Perfectly

38yo mother of 2 children, Weakness, bruising, heavy menstruation
Tachy, purpura, conjunctiva pallor bilaterally
- low WBC
- LOW plt
- hct
- hgb
High PT, PTT, low fibrinogen, high D-dimer
BS : blasts with Auer rods in them

DIC (thrombin, bleeding, fibrin deposition—> ischemia and organ failure)
- usually in malignancy (blasts have more tissue factor) or sepsis
APL : 15:17 translocation a type of AML

How well did you know this?

Not at all

Perfectly

Panocytopenia

Aplastic Anemia
AML/ALL
DIC

How well did you know this?

Not at all

Perfectly

DIC TX

Right away as fast as you can give fluids and platelet transfusion, factor replacement (esp if you see Aure rods and suspect APL)

How well did you know this?

Not at all

Perfectly

What does it usually mean when you see Auer rods

APL (15:17) a type of AML

How well did you know this?

Not at all

Perfectly

APL/AML is what

PML + RARa next to each other
Need to give them RA that it will like
has tissue factor and annexin on surface of cells

How well did you know this?

Not at all

Perfectly

Tissue factor

Annexin2

TF : F10a —> F2a —> Fibrin

Annexin 2 : Plasmin —> D-diners from fibrinogen

How well did you know this?

Not at all

Perfectly

What specific chemo do you give someone who has APL

ATRA : all-trash retinoic acid replaces the RA (VIT A derivative) = short lived
ATO : Arsenic trioxide (causes blasts to force differentiation or apoptosis) = longer lived
** give both

How well did you know this?

Not at all

Perfectly

68yo F elderly women comes in saying she’s fatigues even though she’s had a cream cheese bagel and her stomach is full
10lb weight loss in 2mos, abd fullness, very fatigued
- moderate spelomegally
- EXTREME HIGH WBCs
- low hct
- mild low hgb
- plt normal
- normal MCV
- normal Retic count
- LOW Leukocyte Alkaline Phosphate
BS : all types of cells (mostly mature WBCs)

CML

LOW LAP : alkaline phosphatase + reactive cells (that are reacting to infection, autoimmune or stressed)

How well did you know this?

Not at all

Perfectly

WBC : normal is 4-11

20-30
Over 50

Infection, autoimmune, stress

2. Leukemia (C-diph rip roaring infection)

How well did you know this?

Not at all

Perfectly

What is LAP score

Study These Flashcards

LOW LAP : alkaline phosphatase + reactive cells (that are reacting to infection, autoimmune or stressed) = probability uncontrolled overproduction reason
HIGH LAP : means infection, stress, autoimmune

Confirming CML

Study These Flashcards

BS : many mature WBCs
High Buffy layer when continuing blood (CBC says high WBCs)
Low LAP score
Hypercellular BM
Pseudo-Gaucher cells
Philadelphia chr

CML has what type of anemia

Normocytic mild anemia | You can see high number of platelets

Reason for CML splenomegaly

Due to increased production happening extramedullary when BM cant keep up making right amount and good functioning WBCs

Pseudo-Gaucher cells

High blue M that clean up debri in CML

CML translocation

9:22 ABL-BCR Philadelphia chr Turns on tyrosine kinase

How to TX CML

Gleevec/Imatinib | Blocks TK

Testing for Philadelphia chr

1. FISH fluorescent 2. PCR : most sensitive (1 in 100,000) to find a 9:22 translocation * flow cytometry is not that great

Special thing about CML

It has 3 stages

3 stages of CML

1. Chronic CML phase : fatigue, asymptomatic, CBC has hgih WBCs 2. Accelerated CML : 10-19% blasts circulating, low Plt, 3. Plast phase CML : 20% higher blasts

Causes of Lymphadenopathy

``` M L malignancy I : infection A : autoimmune M : miscellaneous I : Iatrogenic (vaccination) ```

When to really looks into a lymphadenopathy

1. older then 40yo 2. Longer then 4-6 weeks 3. More then 2 locations 4. SUPRACLAVICULAR : everything drains to this so can be any organ or place 5. Fever, night sweats, weight loss, heptatosplenomegally * ***(Hard, 4cm or bigger, subclavian)**** = DO BIOPSY

Tender Lymphadenopathy

Usually benign , HOWEVER | ****However Burkitts and DLBCL (rapid growth of LN = Very tender) and very aggressive

FINE NEEDLE BIPOSY

Not that great Only good if you know exactly what you’re looking for (past patient (Marker detection in flow cytometry)

Core needle biopsy

Good way to do a biopsy and then look at cells under microscope and see what is happening in the BM

Excisional biopsy

GOLD STANDARD Best way to Dx lymphoma (**** only way to dx Hodgkin lymphoma and see the owl cells) Take entire LN out , full picture of the LN

14yo F with abd pain in ER CT : large abd mass next to appendix - after 2 days of Abs the mass grew by 50% - she went to surgery - a bunch of cells in on of the LNs that looks like a starry night What is it

Burkitts Lymphoma - Ruptured appendix = provide Ab and IV - appendix has many LN

Burkitt lymphoma translocation

8:14 IgH/MYC Very aggressive

Burkitt Lymphoma TX

High risk of intracranial involvement 1. Chemotherapy + chemotherapy with intrathecal into CSF (Easy to tx since its fast growing and you target all fast growing cells, however it has room for many complications)

Female with Burkitts lymphoma tx with chemotherapy has stoped making urine - BUN and Cr are very high : kidney failure or down What’s happened

Tumor Lysis Syndrome

Tumor Lysis Syndrome what 4 things happen in

1. High K = arrhythmia (sudden cardiac death) 2. High Uremic acid (nucleuic acids from cells become uremic acid crystals and acute tubular necrosis) 3. High P (binds to free Ca+2 and hides them) 4. LOW Ca+2

Tumor Lysis Syndrome happens when

With rapid killing of tumor cells that are fast growing (there contents spill out) - DLBCL - Hodgkin - Burkitts

How to TX TLS

Give fluids before chemotherapy (flushing kidneys constantly)**** ALLOPURINOL : xanthine oxidase inhibitor (no uric acid)

TX hyperkalemia

Furosemide/LASIX (pee it out) - give glucose/insulin to help since this takes time - if that doesn’t work dialysis

TX hyperuricemia

Rasburicase (allows urate oxidase to happen from uric acid neutralizing it) **** can cause hemolytic anemia in G6PD patients**** KNOW THAT****

TX Hyperphosphatemia or hypocalemia

Calcium Gluconate

22yo male home from college and fatigues easily CP when drinking alcohol Night sweats, fever, jocks itch PE : 10lb last, no lymphadenopathy or splenomegally What should I order :???? Nd what do I SEE???? What biopsy ??? And what should you see

``` CXR : mediastinal widening (unable to see aortic arch ) Excisional biopsy (owl cells, and t-cells all around it) Hodgkin lymphoma (with B sx) ```

Hodgkin Lymphoma is what type of lymphoma

``` Highly inflammatory Has 4 stages 1. Neck 2. Axillar 3. Below liver 4. Many parts involved ```

Hodgkin lymphoma TX

21-28days chemotherapy

Hodgkin Lymphoma likes hiding where

Mediastinum

``` Elderly male, petechiae, fatigue, conjunctiva pallor bilaterally, axillary and cervical Lymphadenopathy - high WBCs - high plt - high hgb BS: many mature lymphocytes (90%) WHAT DOES HE HAVE - he was already DX with this years ago and was told not to worry about it WHAT DOES HE HAVE NOW ```

BS : monoclonal B-cells CLL (+ thrombocytopenia and anemia) Richters Transformation (due to thrombocytopenia and anemia)——> IT BECAME DLBCL

Richters Transformation

CLL ——> DLBCL or another small grade lymphoma to high grade lymphoma

CLL with Richters Transformation TX

Chemotherapy + RITUXIMAB = CD20 inhibitor (better outcome the more fit and healthy the patient is) = treat the DLBCL

How to monitor CLL

Look for B SXs to see if there is a possibility of a Richters Transformation to DLBCL or another HGIH grade lymphoma

What can be more effective then Rituximab

CD19 targeting drug since that is absolutely all B-cells from the stem cells

Dr. Pence - Leukemia And Lymphoma Case Studies Flashcards

(57 cards)