Acute Myeloid Leukaemia

Question 1

Define:

Answer 1

Malignancy of primitive myeloid lineage WBC with proliferation in the bone marrow.

Classified using the FAB (8 variants)

Question 2

Aetiology:

Answer 2

Myeloblasts undergo malignant transformation and proliferation.

This replaces the normal marrow leading to bone marrow failure

Usually due to mutations in the transcription factors

Question 3

Risk factors:

Answer 3

Cancer therapy (alkylating agents) and chemotherapy

Ionising radiation

MPD/MPS

Question 4

Epidemiology:

Answer 4

Incidence increases with age (more common in adults)

Rapid progression

Question 5

Symptoms:

Answer 5

Anaemia (fatigue and dysponea)
Opportunistic infections
Bleeding

Tissue infiltration:
Gum swelling or bleeding
CNS Involvement (headaches, diplopia and nausea)

Question 6

Signs:

Answer 6

Pallor
Bruising (Ecchymosis)
Bleeding
opportunistic or recurrent infections (skin infections, mouth ulcers and fever)

Tissue infiltration:
Hepatosplenomelgaly 
Skin rashes 
Gum hypertrophy 
Deposits in eye, tongue and bone (rare)

Question 7

Investigations:

Answer 7

FBC - low Hb and platelets but variable WCC
High uric acid
High LDH
Clotting - fibrinogen and d-dimer (DIC)

Blood film (myeloblasts, auer rods and bi-lobed nucleus)

Bone marrow aspirate/biopsy - hypercellular >20% blasts

Immunophenotyping (differentiates from ALL)

Cytogenetic (guide prognosis)

Immunocytochemistry