Acute Leukemia Flashcards
What type of blood cells are in acute leukemia? What is their morphology?
Blasts which are large immature cells often with punched out nucleoli.
What is acute leukemia? How does it present?
Neoplastic proliferation of > 20% blasts in the bone marrow. Presents with anemia, thrombocytopenia or neutropenia due to the crowding out of normal hematopoiesis.
What are the subdivisions of acute leukemia?
Acute lymphoblastic leukemia and acute myelogenous leukemia
What stains positive for acute lymphoblastic leukemia? What is it associated with? What are its classifications?
Tdt which is a marker of DNA polymerase. Down syndrome which arises after 5 years of age. B-ALL and T-ALL based on surface markers.
What is the most common type of ALL? What markers is it characterized by? How is it treated? What determines prognosis?
B-ALL, Tdt+ lymphoblasts that express CD10, CD19 and CD20.
Excellent chemo response but prophylaxis to the scrotum and CSF.
T(12;21) good prognosis, kids
T(9:22) poor prognosis, adults (Philadelphia + ALL)
T-ALL has which markers? How does it present?
TdT+ lymphoblasts that expresses markers CD2 to CD8.
Presents in teens as mediastinal (thymic) mass called acute lymphoblastic LYMPHOMA.
What does AML stain positive for? What are characteristic findings on crystal aggregates? Who does it arise in?
Myeloperoxidase. Auer rods. Older adults (50-60 years).
What translocation is acute promyelocytic leukemia characterized by? What does it increase the risk of? How is it treated?
T(15;17) which is translocation of retinoic acid receptor (RAR) on 17 to chromosome 15. RAR disruption leads to promyelocyte accumulation. Increased risk for DIC. Tx with all-trans retinoic acid (ATRA, vitamin A derivative) causes blasts to mature and eventually die.
Is MPO present in Acute Monocytic Leukemia? How does it present?
No. Blasts characteristically infiltrate gums.
Is MPO present in Acute Megakaryoblastic Leukemia? What is it associated with?
No. Down syndrome before age 5.
Which Leukemia is associated with Down syndrome before age 5? After age 5?
AML (Acute Megakaryoblastic leukemia) before 5 and Acute Lymphoblastic leukemia after 5.
What can causes of AML? How does it present?
Myelpdysplastic syndrome especially prior exposure to alkylating agents or radiotherapy. Cytopenias, hypercellular bone marrow, abnormal maturation of cellsa nd increased blasts <20%. Most patients die from infection or bleeding.
