Case 4 Flashcards
What is leukemia?
- Lymphoid neoplasm
- Originates in bone marrow.
- Tumor cells in peripheral blood
Acute Leukemia
- Increased risk in Down Syndrome, Bloom’s Syndrome, Fanconi’s anemia, twins, & exposure to radiation & chemicals
- Labs: low platelets, blasts are large w/punched out nucleoli
- Sx: anemia, thrombocytopenia, neutropenia
- Testing: flow cytometry to confirm
Acute Lymphoid Leukemia (ALL)
- Most common in children & minorities
- Good prognosis
- Associated w/Down Syndrome > age 5
- Sx: abrupt onset, depression of marrow function (anemia, neutropenia and thrombocytopenia), CNS problems
- Labs: normal WBC, but ↓ neutrophils (so WBC are relatively high), TdT+
- Tx: induction chemotherapy, hyperCVAD
B-ALL
- Most common
- CD10, CD19, CD20
- t9:22 Philadelphia chromosome is bad prognostic marker (more commonly seen in CML)
- Tx: Imatinib
T-ALL
- CD2-CD8
* Presents as thymic mass in teenagers
Chronic Lymphocytic Leukemia (CLL)
- Neoplastic proliferation of naïve B-cells (CD5)
- Most common leukemia in elderly (>50)
- Rai staging (0-4)
- Deletion 11q23 & alteration 17p → poor prognosis
- Sx: asymptomatic or or fever, night sweats, weight loss, fatigue
- Labs: ↑ WBC, small lymphocytes & smudge cells in smear
Hairy Cell Leukemia
- Neoplastic proliferation of mature B cells
- Sx: massive splenomegaly, no lymphadenopathy
- Labs: TRAP +
Which mutations give rise acute leukemias?
Mutations that completely arrest maturation early in blood cell development
Which mutations give rise to myelodysplastic disorders?
Mutations that impair and slow blood cell maturation
Which mutation give rise of myeloproliferative disorders?
Mutations that cause autonomous overproduction of mature blood cells and their immediate precursors
What are some possible genetic etiologies for leukemia?
Down Syndrome, Bloom’s Syndrome, Fanconi’s anemia, Li-Fraumini Syndrome, Identical twins
What are some possible exposure etiologies for leukemia?
Radiation, industrial chemicals, alkylating agents, topoisomerase inhibitors, viruses (HTLV)
Multiple Myeloma
- B-cell neoplasm commonly seen in older African Americans
- Chromosome 13 deletion is bad prognostic marker
- Sx: CRAB (Calcium, Renal insufficiency, Anemia, Bone pain/lysis)
- Labs: ↑ globulin, ↑ creatinine, ↑ calcium, ↓ albumin Rouleaux formation on smear, lytic punchout lesions on x-ray, Bence-Jones protein + (in urine)
- Tx: chemo, steroids
MGUS
- Serum protein M spike (<10%
- No end organ damage
- Common in elderly
- 1% chance/year that MGUS → smoldering or multiple myeloma
What is Durie-Salmon staging used for and what is it based on?
Staging for multiple myeloma and based on B-2 micro globulin & serum albumin levels
