Leukemia Flashcards
Definition of Leukemia
-Cancer of the bone marrow and white blood cells
-Proliferation of abnormal WBCs leading to crowding out healthy cells (anemia, thrombocytopenia)
Acute Leukemia
-Abnormal cells are immature blood cells (blasts)
-Rapidly multiplying WBCs crowd out healthy cells
-Cells unable to perform normal functions
-Timely treatment essential
Chronic Leukemia
-More mature blood cells
-Often accumulate more slowly
-May be asymptomatic and found on routine testing
Four Main Categories of Leukemia
-Acute Myeloid Leukemia (AML)
-Acute Lymphoblastic Leukemia (ALL)
-Chronic Myelogenous Leukemia (CML)
-Chronic Lymphocytic Leukemia (CLL)
Acute Myeloid Leukemia (AML)
-Most common form of acute leukemia in adults
-Average age of diagnosis: 67 years old
-Thrombocytopenia
-Anemia
-Malfunction of WBC
-Leukostasis-elevated WBC to CNS and respiratory symptoms
-Other-leukemia cutis, gingival hypertrophy, hepatosplenomegaly, night sweats, DIC
AML Diagnosis
-Anemia, thrombocytopenia, usually elevated WBC with blasts (immature WBC)
***Auer Rods
Diagnostic for myeloid lineage.
Auer Rods are present in the cytoplasm of myeloblasts. They are NOT present in lymphoblasts.
AML Tx and Prognosis
-Chemo
-Bone marrow transplant
Acute Lymphoblastic Leukemia
-Most common childhood malignancy (peak ages 3-5)
-Similar presentation to AML with anemia/thrombocytopenia symptoms
-Lymphadenopathy, hepatosplenomegaly
-Fever, chills, night sweats
CNS symptoms: headache, stiff neck, AMS
-Testicular masses
ALL Diagnosis
-CBC – Often bicytopenia with leukocytosis and blasts Bone Marrow Biopsy and Peripheral Smear
>20% blasts in either blood or bone marrow
-Flow Cytometry
-Lumbar Puncture
-Testicular US
Chronic Myeloid Leukemia
-Uncontrolled proliferation of mature WBCs
-Characterized by Philadelphia chromosome (95% of CML)
-Average age of diagnosis: 64 years old
-Often asymptomatic and found on routine testing (20-50%)
-Splenomegaly (50%)
-Fatigue, weight loss, early satiety, easy bruising/bleeding
CML Dx -Chronic phase (most common), accelerated phase, Blast phase
-CBC with leukocytosis
WBC 25,000 – 300,000
Typically zero to minimal blasts
+/- Thrombocytosis
Philadelphia Chromosome
t(9;22)
Creates BCR-ABL gene that drives cell proliferation
Chronic Lymphocytic Leukemia
-Most common leukemia in adults
-Average age of diagnosis: 70 years old
-Most common in Caucasian males
-Most are asymptomatic at time of diagnosis and found on routine blood testing
-Fatigue, increased infections
-Painless lymphadenopathy
-Hepatosplenomegaly
CLL Dx
-WBC often 10,000 - 50,000
Leukocytosis with lymphocytosis
-Smudge cells on peripheral smear
-Bone Marrow Biopsy
Heme Emergency-Neutropenic Fever
-Severe Neutropenia = Neutrophils <500 on differential
-Fever in neutropenic patient is a medical emergency due to potential infection sepsis septic shock QUICKLY
-Assess for localizing symptoms
-Infectious workup: Blood cultures, CXR, UA, lactate, and any warranted imaging
-Assess for SIRS criteria as indicator for potential sepsis
Heme Emergency-Neutropenic Fever-Tx
-Start antibiotics ASAP
-“Golden Hour”
The “golden hour of sepsis” stresses the relationship between timely initiation of antibiotic treatment and outcome: each hour delay in treatment reduces sepsis survival by 7.6%
-IVF resuscitation 30 cc/kg
-Symptom Control (Tylenol, O2, pain management, etc.)
