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Haematology > Acute Myeloid Leukaemia > Flashcards

Acute Myeloid Leukaemia Flashcards

1
Q

What is acute myeloid leukaemia?

A

https://www.youtube.com/watch?v=itkRVTqfPsE

Neoplastic proliferation of blast cells derived from marrow myeloid elements.

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2
Q

Who does AML most commonly affect?

A

Adults - median age at presentation of 65

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3
Q

What can cause AML?

A
  • Long term complication of chemo
  • Myelodysplastic disease
  • Radiation
  • Down’s Syndrome
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4
Q

What are symptoms seen in AML?

A

Symptoms of marrow failure

  • Fatigue
  • Dyspnoea
  • Symptoms of infection
  • Exacerbated angina/claudication
  • Bleeding and bruising

Symptoms of infiltration

  • Bone pain - less common than ALL
  • Headache
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5
Q

What are signs seen in AML?

A
  • Petechiae/Purpura
  • Fundal Haemorrhage
  • Mucosal bleeding
  • Hepatomegaly
  • Splenomegaly
  • Gum hypertrophy
  • Violaceous skin lesions
  • Signs of CNS involvement - very rare
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6
Q

How would you distinguish AML from ALL?

A

Compared to ALL

  • Bone and Joint pain less common
  • Hepatosplenomegaly less common
  • Organ infiltration quite unusual
  • Lymphoblasts may/may not be present in blood
  • Auer Rods always present
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7
Q

What can occur in acute promyelocytic leukaemia?

A

DIC - due to thromboplastic release

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8
Q

What is the following?

A

Gum hypertrophy

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9
Q

How would you investigate suspected AML?

A
  • Bedside - None
  • Bloods - FBC, U+Es, LFTs, Blood Film, Coagulation screen, Urate, LDH
  • Orifices - none
  • X-ray/imaging - CXR
  • ECG - no
  • Special - Bone marrow Aspirate
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10
Q

What are the following?

A

Petechiae - Small (1–2 mm) haemorrhages into mucosal or serosal surfaces

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11
Q

What are causes of the following?

A
  • Thrombocytopenia of any cause - autoimmune, heparin-induced, hypersplenism
  • Bone marrow failure - malignancy
  • Defective platelet function
  • DIC
  • Infection
  • Bone marrow defects
  • Factor deficiencies
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12
Q

What is the following?

A

Purpura - >3 mm haemorrhages, or when ecchymoses and petechiae form in groups

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13
Q

What are causes of the following?

A

Diseases associated with:

  • As with petechiae:
    • Trauma
    • Vasculitis – particularly palpable purpura
    • Amyloidosis
    • Over-anticoagulation
    • Factor deficiencies
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14
Q

What is the following?

A

Auer Rods - clumps of azurophilic granular material that form elongated needles seen in the cytoplasm of myeloid leukemic blasts.

THESE ARE PATHOGNOMIC FOR AML

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15
Q

What might you see on FBC in someone with AML?

A
  • Increased WCC, but can be normal/low
  • Normocytic, normochromic anaemia
  • Thrombocytopenia
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16
Q

What might you see on blood film in someone with AML?

A
  • Blasts cells - not many, less than ALL
  • Auer Rods
17
Q

What might you see on Bone marrow aspirate in someone with AML?

A
  • Increased cellularity, reduced erythropoiesis, reduced megakaryocytes.
  • Replacement by blast cells >20%
  • Lineage confirmation by immunophenotyping
    • AML – CD33 or CD13
18
Q

What cytogenetic techniques would you request for testing bone marrow samples in someone with suspected AML?

A
  • Flow cytometry immunophenotyping.
  • Fluorescent in-situ hybridisation (FISH) - examines chromosome number and translocations, importantly the Philadelphia chromosome (9;22 translocation present in 90% of CMLs)
  • PCR sequencing for DNA mutations - such as JAK-2
19
Q

How would you manage someone with AML?

A
  • Supportive therapy
  • Chemotherapy
  • Bone marrow transplant
20
Q

What supportive therapy would you use in AML?

A
  • Blood/Platelet transfusion
  • IV fluids
  • Allopurinol
  • Hickman/Subcut line - IV access
21
Q

Why would you give allopurinol to someone as supportive therapy for AML?

A

To try to prevent tumour lysis syndrome

22
Q

What chemotherapeutic regimen is often used in AML?

A

Long periods of marrow suppression, with 5 cycles in 1 week blocks

  • Daunorubicin
  • Cytarabine
23
Q

Which mutation can make AML more sensitive to cytarabine?

A

RAS mutation - present in approx 20% patients

24
Q

What type of bone marrow transplants are used in AML?

A

Allogenic from HLA-matched siblings or matched unrelatedd donors

25
Q

How is a bone marrow transplant performed in AML?

A

Destroy leukaemia and immune system with cyclophosphamide + total body irradiation. Then repopulate with transplanted marrow

26
Q

What is used to prevent graft vs host disease?

A

Ciclosporin +/- methotrexate

27
Q

What complications can occur in AML?

A
  • Infection - bacterial, fungal or viral
  • Increased plasma urate - from chemo
  • Leukostasis - Dramatically increased WCC
28
Q

What is leukostasis?

A

A medical emergency most commonly seen in patients with acute myeloid leukemia or chronic myeloid leukemia in blast crisis. It is characterized by an extremely elevated blast cell count and symptoms of decreased tissue perfusion.

The pathophysiology of leukostasis is not well understood, but inadequate delivery of oxygen to the body’s cells is the end result. Leukostasis is diagnosed when white cell plugs are seen in the microvasculature

29
Q

What are symptoms of leukostasis?

A

Dyspnoea

Neurological symptoms

  • Visual changes
  • Headache
  • Dizziness
  • Tinnitus
  • Gait instability
  • Confusion
  • Somnolence
  • Coma.
30
Q

What are signs of leukostasis?

A
  • Hypoxia
  • Pulmonary infiltrates
  • Reduced GCS
  • Retinal vein dilatation
  • Papilloedema
  • Fundal haemorrhage
31
Q

What are complications of treatment for AML?

A
  • Graft vs host disease
  • Opportunisitc infection
  • Relapse of leukaemia
  • Infertility
32
Q

What are characteristics of blast cells?

A

An immature precursor of myeloid cells or lymphoid cells:

  • Bigger than normal counterpart
  • Immature nucleus (nucleolus, open chromatin)
  • Cytoplasmic appearances often atypical
  • Rarely ever seen in serum of normal individuals

If present, are highly suggestive of an acute leukaemia or a chronic disorder that is beginning to transform into an acute disease

33
Q

How would you treat acute promyelocytic leukaemia??

A

all-trans retinoic acid (ATRA)

34
Q

What features assocaited with a picutre of bone marrow failure/an acute leukaemia might point away from AML as a cause and towards ALL as a cause?

A

Fever and lymphadenopathy are common first signs in ALL, whereas these are rare in AML

Haematology (34 decks)

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