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SBL > Acute/Chronic Leukemia case studies > Flashcards

Acute/Chronic Leukemia case studies Flashcards

1
Q

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

A

Myelodysplastic Syndromes

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2
Q

How do Myelodysplastic Syndromes usually present?

A

Cytopenias and dismorphic blood cells

Anemia with macrocytosis

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3
Q

How do Myelodysplastic Syndromes usually present?

A

Cytopenias with dismorphic blood cells

Anemia with macrocytosis

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4
Q

Myelodysplastic Syndromes are precursors for?

A

Acute Myeloid Leukemia

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5
Q

Acute Myeloid Leukemia is defined as?

A

Greater than 20% myeloid blasts in the bone marrow

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6
Q

How do you calculate severe neutropenia (ANC)?

A

(%neutrophils + %bands) X WBC

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7
Q

ANC < 500 =

A

Severe Neutropenia

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8
Q

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

A

Neutropenic fever

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9
Q

4 steps to confirming neutropenic fever?

A
  1. Physical exam and culture 2 sets of blood + 1 urine
  2. Chest X-ray
  3. Empiric antibiotics
  4. Start chemotherapy for AML
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10
Q

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

A

Gram NEGATIVE (ex. pseudomonas)

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11
Q

Empiric antibiotics to treat gram (-) infections

A

Cefepine
Piperacillin-tazobactum
Meropenem
Ceftazidine

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12
Q

What can you add to empiric antibiotics to treat MRSA

A

Vancomycin

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13
Q

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

A

Fungal coverage antibiotics (ex. candida)

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14
Q

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

A

Central line

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15
Q

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

A

Central line

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16
Q

Initial chemo to induce remission

A

Induction chemo

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17
Q

Intense chemo to kill all cancer cells in the body

A

Consolidation chemo

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18
Q

Longer term chemo to maintain remission

A

Maintenance chemo

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19
Q

Translocation associated with Acute Promyelocytic Leukemia?

20
Q

t(15;17)

A

Acute Promyelocytic Leukemia

21
Q

What are seen in cells of Acute Promyelocytic Leukemia?

22
Q

What serious condition can Acute Promyelocytic Leukemia cause?

A

DIC

Disseminated Intravascular Coagulation

23
Q

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

A

Tissue factor - activates factor X to clot

Annexin II - activates plasmin to degrade clots

24
Q

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

A
  1. Consumption of platelets and coagulation factors = bleed

2. Fibrin deposition = organ failure

25
Q

With DIC what are the levels for:

PTT/PT, D-dimer, Fibrinogen, platelets

A

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

26
Q

Physical symptoms of DIC?

A

Bruising, heavy periods, conjunctival pallor

27
Q

How do you treat DIC and Acute Promyelocytic Leukemia?

A

Give platelets and clotting factors (quickly!)

- Chemotherapy

28
Q

What are 2 chemotherapy options for Acute Promyelocytic Leukemia?

A
  1. ATRA

2. ATO (arsenic trioxide)

29
Q

Until proven otherwise, what does extreme leukocytosis indicate?

30
Q

Moderate leukocytosis could indicate what types of things?

A

Stress, infection, autoimmune

31
Q

LAP scores stands for?

A

Leukocyte Alkaline Phosphatase

32
Q

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

A

Reactive conditions, such as leukemoid reaction

33
Q

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

A

Abnormal myelocyte population = NEOPLASM

34
Q

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

A

Absent stain = (-)/low

35
Q

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

A

CML (chronic myeloid leukemia)

36
Q

What does the bone marrow look like with CML?

A

HYPERcellular consisting of mature myeloid cells

37
Q

t(9;22) creates a?

A

Constitutively active tyrosine kinase that is ATP dependent

38
Q

What cells can be seen with CML?

A

Pseudo-gaucher cells (blue/green macrophages)

- job is to clean up cell debris from the fast cell turnover

39
Q

Hypercellular bone marrow with pseudo-gaucher cells indicates?

40
Q

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

A

Imatinib (gleevec)

41
Q

Imatinib treats?

42
Q

How does Imatinib (gleevec) work?

A

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

43
Q

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

A

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

44
Q

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

A

PCR amplification

45
Q

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

A

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

SBL (48 decks)

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