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Flashcards in Hematologic Malignancies Deck (15)
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1

 

 

ANEMIA

 

a condition marked by a deficiency of red blood cells or of hemoglobin in the blood, resulting in pallor and weariness.

(Hct 25-30%, Hgb 8-10g/dl).  Results in  pallor, fatigue, SOB, general malaise, activity intolerance.

2

 

Thrombocytopenia

deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury.

pt below 20,000 cells/μl. Petichiae, easy bruising, bleeding gums, hematuria, retinal hemorrhage, intracranial bleed.

3

 

Neutropenia

the presence of abnormally few neutrophils in the blood, leading to increased susceptibility to infection. 

ANC (absolute neutrophil count) less than 500 cells/μl.  Protective isolation.  At high risk for infections, esp. opportunistic.  

Decrease in WBC!!

4

 

Infiltrative manifestations

 

Lymphadenopathy, joint pain and swelling, weight loss, anorexia, hepatomegaly, splenomegaly

5

 

CNS infiltration

 

Can occur with any leukemia-increased ICP, seizures, changes in mental status

6

 

Understand method of diagnosis for

leukemias and lymphomas

 

Leukemias: must be done with bone marrow aspiration Typically of the hip bone

Called leukemia when present in blood and bone marrow

 

Lymphomas: lymph node biopsy followed by histology 

Called lymphoma when localized in lymph tissue

7

 

Acute leukemia

 

happens when most of the abnormal blood cells stay immature and can’t carry out normal functions. It can get bad very fast.

Rapid growth of immature blood cells (blasts).  Crowds bone marrow, unable to produce other, healthy cells.  Immediate treatment necessary due to rapid progression.  Death in months or weeks without treatment (ppt definition)

8

 

Chronic leukemia

 

happens when there are some immature cells, but others are normal and can function normally. That means it gets bad, but more slowly.

Excessive buildup of relatively mature but abnormal blood cells.  Progresses over months to years. (ppt definition)

9

 

Acute Myeloid Leukemia: AML

Presentation:   Bone marrow aspirate must have more than 20% blasts to be considered AML

Number of subtypes based on what stage in differentiation the development becomes malignant.

S/S: bone pain, anemia, thrombocytopenia, increased susceptibility to infection.

Age: Median age 64y/o

Treatment: The treatment is based on the subtype of AML. 

Two phases of treatment-remission induction and consolidation/postremission.

4 year survival 30-40%, less in elderly patients

Stem cell transplant an option but mortality 10-25%

10

 

Chronic Myeloid Leukemia: CML

15% of leukemia cases

Cause: Very specific gene that goes wrong and is the cause of CML. Oncogene: Philadelphia chromosome

Majority of cases are malignant granulocytes w/ Philadelphia chromosome

Presentation: high granulocyte count on CBC, splenomegaly.  

S/S: fatigue, weight loss, sweats, bleeding, abdominal discomfort (spleen)

Age: 40-50yrs 

Treatment: Standard Chemo only produces temporary remission. Untreated survival rate of 2 years. ONLY CURE: is allogenic stem cell transplant, even with this about 50% cure rate. If progresses to blast crisis (increase in immature cells), prognosis very poor

11

 

Acute Lymphoid Leukemia: ALL

Cause: 80% are B-cell in origin, 20% T-cell

Presentation: Multiple genetic subtypes

At least 20% of bone marrow cells must be blasts for ALL diagnosis

Crowd out other normally functioning cells in bone marrow

S/S:  abrupt onset of bone pain, bruising, fever, infection, loss of appetite.  May see enlarged liver, lymph nodes, spleen.

Age: Peak incidence 3-7y/o, with second smaller peak in middle age

Treatment: Very curable in children (85%), but lower survival in adults (30-50%)

Cyclical chemotherapy administration

Will need chemo to continue for several years after remission is achieved

If recurs, can do stem cell transplant

12

 

Chronic Lymphoid Leukemia: CLL

30% of all adult leukemia cases.

Cause: 95% of cases due to a malignant B-cell precursor; 

T-cell cases more aggressive and harder to treat. 

Presentation: Often found by accident on routine CBC because remains asymptomatic for long period

S/S:  fatigue, weight loss, anorexia.  Leukemic B-cells do not produce antibodies normally, so increased infections.

Age: Depending on genetics and subtype, can have survival up to 24 years

Treatment: May not treat since so many live with manageable symptoms and the disease is slow progressing.

May consider stem cell transplant-weigh risks and benefits

13

 

Multiple myeloma

AKA cancer of plasma cells.

The plasma cells are a type of white blood cell in the bone marrow. With this condition, a group of plasma cells becomes cancerous and multiplies. The disease can damage the bones, immune system, kidneys, and red blood cell count

Cell Responsible:  Plasma Cells

Malignant disorder of mature, antibody secreting B-cells (called plasma cells).

Can invade bone, spleen, liver, kidneys, lymph nodes and form multiple tumors

Excessive production of antibodies of a single type

Accumulation of antibody fragments in blood and urine (called Bence Jones proteins in urine), can cause kidney damage.

Also cause bone lesions with pathologic fractures

S/S: many due to bone and renal damage; hypercalcemia.  As progresses, other symptoms from bone marrow crowding

Treatment: antineoplastics, survival about 3 years.  May do stem cell transplant

Age: Median age of presentation is 65, and more common in men

14

 

Hodgkin Disease

Cell Responsible:  Malignant disorder of lymph nodes, presence of Reed-Sternberg cells (originate from B-cells in the germinal centers of lymph nodes)

Metastasize pattern is very predictable 

½ of cases between 20-40 y/o, more common and more severe in males

Manifestations: painless lymph node enlargement (usually above diaphragm), fever, night sweats, weight loss, malaise

Treatment: includes radiation, often in combo with antineoplastics.

5-year survival for treated disease is 85%

15

 

Non-Hodgkin Lymphoma

All other lymphomas that do not have Reed-Sternberg cells.

S/S is similar to Hodgkin disease but spreads much quicks and less predictable

Most occur in older adults, males slightly higher risk, increased risk in AIDS

5-year survival with treatment 50%, as patients often do not present until disease is advanced.