Acute/Chronic Leukemia case studies

Question 1

What are age-related acquired genetic damage to hematopoietic cells that causes ineffective erythropoiesis?

Answer 1

Myelodysplastic Syndromes

Question 2

How do Myelodysplastic Syndromes usually present?

Answer 2

Cytopenias and dismorphic blood cells

Anemia with macrocytosis

Question 3

How do Myelodysplastic Syndromes usually present?

Answer 3

Cytopenias with dismorphic blood cells

Anemia with macrocytosis

Question 4

Myelodysplastic Syndromes are precursors for?

Answer 4

Acute Myeloid Leukemia

Question 5

Acute Myeloid Leukemia is defined as?

Answer 5

Greater than 20% myeloid blasts in the bone marrow

Question 6

How do you calculate severe neutropenia (ANC)?

Answer 6

(%neutrophils + %bands) X WBC

Question 7

ANC < 500 =

Answer 7

Severe Neutropenia

Question 8

What can be seen with AML if there is a fever and severe neutropenia present?

Answer 8

Neutropenic fever

Question 9

4 steps to confirming neutropenic fever?

Answer 9

1. Physical exam and culture 2 sets of blood + 1 urine
2. Chest X-ray
3. Empiric antibiotics
4. Start chemotherapy for AML

Question 10

With empiric antibiotics, what type of bacteria should you treat first?

Answer 10

Gram NEGATIVE (ex. pseudomonas)

Question 11

Empiric antibiotics to treat gram (-) infections

Answer 11

Cefepine
Piperacillin-tazobactum
Meropenem
Ceftazidine

Question 12

What can you add to empiric antibiotics to treat MRSA

Answer 12

Vancomycin

Question 13

If the neutropenic fever does not resolve in 48 hours after administering empiric antibiotics, what should you give?

Answer 13

Fungal coverage antibiotics (ex. candida)

Question 14

Induction chemotherapy involves a 2 week hospital course stay. What is placed to administer chemo?

Answer 14

Central line

Question 15

If after a central line is placed, a new fever arises, what should be cultured?

Answer 15

Central line

Question 16

Initial chemo to induce remission

Answer 16

Induction chemo

Question 17

Intense chemo to kill all cancer cells in the body

Answer 17

Consolidation chemo

Question 18

Longer term chemo to maintain remission

Answer 18

Maintenance chemo

Question 19

Translocation associated with Acute Promyelocytic Leukemia?

Answer 19

t(15;17)

Question 20

t(15;17)

Answer 20

Acute Promyelocytic Leukemia

Question 21

What are seen in cells of Acute Promyelocytic Leukemia?

Answer 21

Auer Rods

Question 22

What serious condition can Acute Promyelocytic Leukemia cause?

Answer 22

DIC

Disseminated Intravascular Coagulation

Question 23

What do Acute Promyelocytic Leukemia cells contain on them that can lead to DIC?

Answer 23

Tissue factor - activates factor X to clot

Annexin II - activates plasmin to degrade clots

Question 24

DIC involves widespread thrombin generation. What does this lead to?

Answer 24

1. Consumption of platelets and coagulation factors = bleed

2. Fibrin deposition = organ failure

Question 25

With DIC what are the levels for: | PTT/PT, D-dimer, Fibrinogen, platelets

Answer 25

PTT/PT - increased D-dimer - increased Fibrinogen - decreased Platelets - decreased

Question 26

Physical symptoms of DIC?

Answer 26

Bruising, heavy periods, conjunctival pallor

Question 27

How do you treat DIC and Acute Promyelocytic Leukemia?

Answer 27

Give platelets and clotting factors (quickly!) | - Chemotherapy

Question 28

What are 2 chemotherapy options for Acute Promyelocytic Leukemia?

Answer 28

1. ATRA | 2. ATO (arsenic trioxide)

Question 29

Until proven otherwise, what does extreme leukocytosis indicate?

Answer 29

Leukemia

Question 30

Moderate leukocytosis could indicate what types of things?

Answer 30

Stress, infection, autoimmune

Question 31

LAP scores stands for?

Answer 31

Leukocyte Alkaline Phosphatase

Question 32

If the LAP score is (+) for stain that indicates?

Answer 32

Reactive conditions, such as leukemoid reaction

Question 33

If the LAP score is (-) for stain that indicates?

Answer 33

Abnormal myelocyte population = NEOPLASM

Question 34

If a neoplasm is present, what will the LAP score be?

Answer 34

Absent stain = (-)/low

Question 35

A HIGH WBC, LOW LAP score and t(9;22) indicates?

Answer 35

CML (chronic myeloid leukemia)

Question 36

What does the bone marrow look like with CML?

Answer 36

HYPERcellular consisting of mature myeloid cells

Question 37

t(9;22) creates a?

Answer 37

Constitutively active tyrosine kinase that is ATP dependent

Question 38

What cells can be seen with CML?

Answer 38

Pseudo-gaucher cells (blue/green macrophages) | - job is to clean up cell debris from the fast cell turnover

Question 39

Hypercellular bone marrow with pseudo-gaucher cells indicates?

Answer 39

CML

Question 40

What is the treatment for CML (chronic myeloid leukemia)?

Answer 40

Imatinib (gleevec)

Question 41

Imatinib treats?

Answer 41

CML

Question 42

How does Imatinib (gleevec) work?

Answer 42

Tyrosine kinase inhibitor that controls the ATP-dependent process - CML creates a always active tyrosine kinase

Question 43

How can FISH detect if the BCR-ABL translocation seen with CML is present?

Answer 43

Red and green markers are assigned to BCR and ABL and will fuse into yellow if the t(9;22) is present

Question 44

What is the most sensitive method to detect for the CML (BCR-ABL - 9;22) translocation?

Answer 44

PCR amplification

Question 45

If CML moves into the accelerated phase and then the blast phase, what will help to signal that?

Answer 45

Accelerated phase - basophilia, increased blasts and decreased platelets Chronic phase - major increase in blasts