DD of Leukemia Flashcards
What are the differentials of leukemia?
- Leukemoid reaction: WBCs >30 000 + immature WBCs (normal is 4000-11000)
- myelosclerosis: proliferation of fibrous tissue in the bone marrow
- neutrophilia: >8000 (normal is 2500-7500)
- eosinophilia: >400 (normal is 40-400)
- lymphocytosis: >4000 (normal is 1500-4000)
What are the types of leukemoid reactions?
- myeloid leukemoid reaction -> neutrophils, basophils, eosinophils
- lymphatic leukemoid reaction -> lymphocytes -> T cells, B cells, natural killers
What are the causes of myeloid leukemoid reaction?
- hemolysis or hemorrhage -> bone marrow attempts to compensate
- BM irritation -> lymphoma, multiple myeloma, bone metastasis)
What are the causes of lymphatic leukemoid reaction?
INFECTIONS
- infectious mononucleosis
- CMV -> could lead to CLL
- pertusis
How are leukemoid reactions differentiated from leukemia?
- immature (blast) cells are never > 5% (in acute leukemia >25 000)
- RBCs & platelets are normal
What is the etiology of myelosclerosis?
- abnormal megakaryocyte precursors release platelet derived growth factor -> stimulates fibroblasts
- some stem cells escape to circulation -> extramedullary hematopoiesis
What is the clinical picture of myelosclerosis?
- hepatomegaly, splenomegaly, & lymphadenopathy
- aplastic anemia (decreased RBCs)
- platelets are increased initially but defective -> thrombocytopenia -> hemorrhage
- decreased WBCs -> infections
What will be shown on CBC & biopsy of myelosclerosis?
CBC
- normocytic normochromic anemia -> reticulocytes increased
- platelets -> high initially then decrease
- WBCs -> basophilia early but later on leucopenia
pruritis, peptic ulcer due to basophilia in early stages (increased histamine)
BM aspiration
- dry tap
- fibrosis
How is myelosclerosis treated?
- supportive treatment: blood transfusions, platelet transfusions, antibiotics
- chemotherapy: Busulphan & hydroxyurea
- splenic irradiation or splenectomy if severe hypersplenism
- allopurinol for gout
- anti-histamine for pruritis
What is the prognosis for myelosclerosis?
- median survival -> 3 years
- 10 - 20% transform to AML
What are the causes of neutrophelia (leucocytosis)?
- infections -> bacterial pyogenic organisms
- tissue damage
- acute hemorrhage or hemolysis
- corticosteroids -> increases neutrophils & eosinophils but decreases other types
- leukemia &leukemoid reaction
What is the difference between granulocytopenia & agranulocytosis?
- granulocytopenia -> leukocytes <1500
- agranulocytosis -> <500
What are the causes of neutropenia?
- drugs -> antibiotics, ANTITHYROID, anticonvulsants, or antimitotic
- idiopathic chronic neutropenia
- causes of pancytopenia -> aplastic anemia, hypersplenism, BM failure
What is the clinical picture of neutropenia?
INFECTION
- in areas already occupied by bacteria -> oropharynx, genito-urinary, GIT, & skin
- high fever with no pus
- complications -> septicemia with septic shock, Waterhouse Freidriechsen syndrome (hemorrhagic purpura + adrenal failure), ulceration & bleeding
CP of the cause
What will be found on lab investigations of granulocytopenia?
- very low WBCs
- normal RBCs & platelets (unless the cause was pancytopenia)
- absent myeloblasts in BM
How is granulocytopenia treated?
- treat cause
- antibiotics, antivirals, or antifungals
- gammaglobulin transfusion
- G-colony stimulating factor -> stimulates synthesis of neutrophils by BM
What are the causes of eosinophilia?
- parasitic infestation
- allergy (asthma, eczema, psoriasis)
- collagen disorders (PAN)
- pulmonary eosinophilic syndrome
- Addison disease -> no cortisol -> eosinophils increase
- IBD
- familial
What are the causes of eosinopenia?
- Cushing syndrome -> increased cortisol -> decreased eosinophils
- corticosteroid therapy
- pyogenic infections
What are the causes of lymphocytosis?
- lymphatic leukemia
- lymphoma
- viral infections
- pertussis
- IMN, CMV, toxoplasmosis
- Coxakie A virus
- TB, brucellosis
