40 - Acute Leukemia

Question 1

What are the two types of acute leukemias?

Answer 1

• Acute myelogenous leukemia (AML)

- Acute lymphoblastic leukemia (ALL)

Question 2

What causes AML (acute myelogenous leukemia)?

Answer 2

• Ionizing radiation (e.g. atomic bomb survivors, prior radiation therapy)
• Benzene
• Increased incidence with Down’s patients
• Myeloproliferative or Myelodysplastic syndromes
• Chemotherapy can cause treatment-related AML

Question 3

What is the typical clinical presentation of AML?

Answer 3

BLEEDING *****

• Nosebleeds
• Melana (dark, tarry stools)
• Hematuria
• Purpura

TEST Q

Question 4

What are the other clinical presentations of AML?

Answer 4

• Malaise, pallor, weight loss, fever and bleeding (KNOW THIS WHOLE SENTENCE)
• Bone pain, sternal tenderness, fatigue, weakness, neutropenic infections, leukocytosis
• Abdominal fullness, early satiety & LUQ pain in those with splenomegaly
• HA, nausea & emesis as a sign of CNS bleeding

Question 5

What is the main cause of death in AML?

Answer 5

• INFECTION *** (70%)
• Hemorrhage from thrombocytopenia (10%)

TEST Q

Question 6

How do you diagnose AML?

Answer 6

• Look for AUER RODS ** on a peripheral blood smear
• Also, symptoms, H&P, abnormal serologic counts, bone marrow studies, etc.

TEST Q***

Question 7

What are of patients do we typically see AML in?

Answer 7

TEST Q ***

• Older adults
• Greater than 60 yrs***

Question 8

What is ALL? Who do we typically see ALL in?

Answer 8

Acute lymphoblastic leukemia

• PRIMARILY A DISEASE OF CHILDREN ***
• 75% of ALL patients are less than 15 years old
• There are only about 1000 adult cases each year, meaning that 80% of adult leukemias are AML and less than 20% adult leukemias are ALL
• Increased incidence in Down’s patients

TEST Q***

Question 9

What is the typical patient presentation of ALL?

Answer 9

BLEEDING - same as AML ***

• nosebleeds
• melana
• hematuria
• purpura

KNOW BLEEDING FOR BOTH AML AND ALL *****

Question 10

What else will we see in the patient presentation of ALL?

Answer 10

• Malaise, pallor, weight loss, fever and bleeding
• Bone pain, sternal tenderness
• Abdominal fullness, early satiety & LUQ pain in those with splenomegaly
• CNS meningeal involvement (more often in ALL) may produce stiff neck, papilledema and cranial nerve palsies

Question 11

Which type of leukemia will present with more lymphadenopathy?

Answer 11

ALL

• Because there is an extra L
• Present in 50% of ALL and very uncommon in AML

Question 12

Describe hepatosplenomegaly

Answer 12

• Common in ALL as well (2/3 of ALL patients)

- AML will have splenomegaly (50%) but NOT hepatomegaly (very uncommon)

Question 13

For ALL, what patients have a good prognosis? Which have a bad prognosis?

Answer 13

Good prognosis
- Children

Bad prognosis ***

• Infants
• Adults

Prognosis is MUCH WORSE in infants and adults ** TEST Q **

Question 14

Which leukemia is more common to have CNS problems (altered mental status, seizures)?

Answer 14

ALL