Acute Myeloid Leukaemia

Question 1

What is AML?

Answer 1

Cancer of the myeloid cell line

Cells responsible for production of granulocytes, monocytes, erythrocytes, and platelets

Question 2

Who is AML most common in?

Answer 2

Elderly patients age 60+

Can come about secondary to a myeloproliferative disorder

Question 3

How does AML present?

Answer 3

Pancytopenia associated symptoms
Abdominal fullness due to hepatosplenomegaly
Bone pain due to increased cell production
Lymph node pain due to lymphadenopathy
gum swelling

Question 4

How is AML investigated?

Answer 4

FBC and blood film-
Low normal cells and high abnormal cells ‘blasts’ (high nuc:cyt, large nucleolus), Auer rods
Coagulation screen for DIC

for definitive diagnosis- immunophenotyping bone marrow aspirate

Question 5

What would you expect to see on bone marrow aspirate immunophenotyping?

Answer 5

CD13
CD33
CD34
CD45
CD117
HLA-DR

Question 6

How is AML managed?

Answer 6

Supportive care

3-4 chemotherapy cycles
Stem cell transplants

For long term central venous access- Hickman line

Question 7

What are the complications of AML?

Answer 7

Consequences of pancytopenia symptoms-

Susceptibility to infection due to neutropenia, fatigue and weakness due to anaemia, easy bleeding and bruising due to thrombocytopenia

Question 8

What are the complications of AML treatment?

Answer 8

Nausea and vomiting
Hair loss
Hepatic/renal dysfunction
Tumour lysis syndrome

Bacterial infection -> treated with broad spectrum antibiotics (particularly gram -ve) when neutropenic fever presents

Also possible to get fungal and protozoal infections