Acute Myeloid Leukaemia

Question 1

What is AML?

Answer 1

malignancy of primitive myeloid lineage white blood cells (myeloblasts) with proliferation in the BM + blood
Failure in production of end cells e.g. neutrophils, monocytes, platelets

Question 2

How is AML classified?

Answer 2

Using the FAB (French-American-British) System into 8 morphological variants

Question 3

Describe the aetiology of AML

Answer 3

Myeloblasts undergo malignant transformation + proliferation
Leads to replacement of normal marrow + BM failure

Question 4

Describe the epidemiology of AML

Answer 4

MOST COMMON acute leukaemia in ADULTS

Incidence INCREASES with age

Question 5

List 3 symptoms caused by bone marrow failure in AML

Answer 5

Anaemia (lethargy, dyspnoea)
Bleeding (due to thrombocytopaenia or DIC)
Opportunistic or recurrent infections

Question 6

List 2 symptoms caused by tissue infiltration in AML

Answer 6

Gum swelling or bleeding  
CNS involvement (headaches, nausea, diplopia)

Question 7

List 5 signs of bone marrow failure in AML

Answer 7

Pallor  
Cardiac flow murmur  
Ecchymosis  
Bleeding  
Opportunistic or recurrent infections (e.g. fever, mouth ulcers, skin infections)

Question 8

List 3 signs of tissue infiltration in AML

Answer 8

Skin rashes
Gum hypertrophy
Deposit of leukaemic blasts in the eye, tongue + bone (RARE)

Question 9

What bloods are investigated in AML?

Answer 9

FBC: low Hb, low platelets, variable WCC
High uric acid
High LDH
Clotting studies, fibrinogen + D-dimers (to identify DIC)

Question 10

What is seen on blood film in AML?

Answer 10

Abundant Myeloblasts

Granulated + Auer rod content of blasts confirms AML.

Question 11

What diagnostic test is definitive for AML?

Answer 11

Bone Marrow Aspirate or Biopsy

Hypercellular with > 20% myeloblasts

Question 12

What other tests may be performed in AML?

Answer 12

Immunophenotyping

Cytogenetics

Question 13

What are Auer rods?

Answer 13

red staining, needle-like bodies seen in the cytoplasm