Acute Myeloid Leukaemia Flashcards
what is the definition of AML?
Cancer of myeloid derived cells resulting in the abnormally large production of blood cells from the bone marrow
what is the epidemiology of AML?
rare disease, Commonest leukaemia in adults
84-89 average age at presentation
what is the aetiology of AML?
Usually not hereditary
Associated with down’s syndrome
what are the risk factors for AML?
AML can occur at any age, but it becomes more common as people get older Being male Smoking Being exposed to certain chemicals Being treated with certain chemotherapy drugs Being exposed to radiation Having certain blood disorders Having a genetic syndrome
what is the pathophysiology of AML?
MDS progresses to AML
The neoplastic proliferation of blast cells derived from marrow myeloid (gives rise to basophils, neutrophils and eosinophils) elements
what are the key presentation of AML?
Marrow failure - anaemia., infection, bleeding
what are the signs of AML?
Anaemia - Pallor, cardiac flow murmur Infection signs Bleeding - low platelet counts Hepatomegaly and splenomegaly Gum hypertrophy DIC could occur
what are the symptoms of AML?
Anaemia - breathless, fatigue, angina. Claudication
Infection - fever, mouth ulcers
Bleeding - bruising, bleeding
what are the first line investigations for AML?
FbC and Blood film - blast cells with arrow rods in peripheral blood, WBC could be raised, MCV - raised
what are the gold standard investigations for AML?
Bone marrow biopsy
Genetic morphology - Minimum 20% blasts for AML (under this = MDS)
Cytogenetics - abnormal karyotype, can be normal
Microscopy, immunophenotyping, molecular methods
what are the differential diagnoses for AML?
B12/folate or mixed anaemia Infection (e.g. herpes virus) Medications Autoimmune Liver disease(e.g.cirrhosis)
how is AML managed?
Blood and platelet transfusions
Neutropenia may lead to deadly infections - treat with prophylactic antivirals, antibacterial and anti fungals
ALLOPURINOL (prevents tumour lysis syndrome)
IV fluids - insert Hickman line (permanent cannula into main vessel, tunnelled under subcutaneous fat so harder for infection to arise) so can easily take blood for testing and administer drugs and fluids
Chemotherapy - intensive 5-6 weeks
Marrow transplantation
how is AML monitored?
Chemo intensive over weeks, regular tests to check cancer progress
what are the complications of AML?
Side effects from chemo
Rapid death, within 2 months is not treated
Be alert to septicaemia, infection could present oddly
what is the prognosis of AML?
5 year survival rate = 15%
Much better if younger
