Hematologic Malignancies Flashcards
ANEMIA
a condition marked by a deficiency of red blood cells or of hemoglobin in the blood, resulting in pallor and weariness.
(Hct 25-30%, Hgb 8-10g/dl). Results in pallor, fatigue, SOB, general malaise, activity intolerance.
Thrombocytopenia
deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury.
pt below 20,000 cells/μl. Petichiae, easy bruising, bleeding gums, hematuria, retinal hemorrhage, intracranial bleed.
Neutropenia
the presence of abnormally few neutrophils in the blood, leading to increased susceptibility to infection.
ANC (absolute neutrophil count) less than 500 cells/μl. Protective isolation. At high risk for infections, esp. opportunistic.
Decrease in WBC!!
Infiltrative manifestations
Lymphadenopathy, joint pain and swelling, weight loss, anorexia, hepatomegaly, splenomegaly
CNS infiltration
Can occur with any leukemia-increased ICP, seizures, changes in mental status
Understand method of diagnosis for
leukemias and lymphomas
Leukemias: must be done with bone marrow aspiration Typically of the hip bone
Called leukemia when present in blood and bone marrow
Lymphomas: lymph node biopsy followed by histology
Called lymphoma when localized in lymph tissue
Acute leukemia
happens when most of the abnormal blood cells stay immature and can’t carry out normal functions. It can get bad very fast.
Rapid growth of immature blood cells (blasts). Crowds bone marrow, unable to produce other, healthy cells. Immediate treatment necessary due to rapid progression. Death in months or weeks without treatment (ppt definition)
Chronic leukemia
happens when there are some immature cells, but others are normal and can function normally. That means it gets bad, but more slowly.
Excessive buildup of relatively mature but abnormal blood cells. Progresses over months to years. (ppt definition)
Acute Myeloid Leukemia: AML
Presentation: Bone marrow aspirate must have more than 20% blasts to be considered AML
Number of subtypes based on what stage in differentiation the development becomes malignant.
S/S: bone pain, anemia, thrombocytopenia, increased susceptibility to infection.
Age: Median age 64y/o
Treatment: The treatment is based on the subtype of AML.
Two phases of treatment-remission induction and consolidation/postremission.
4 year survival 30-40%, less in elderly patients
Stem cell transplant an option but mortality 10-25%
Chronic Myeloid Leukemia: CML
15% of leukemia cases
Cause: Very specific gene that goes wrong and is the cause of CML. Oncogene: Philadelphia chromosome
Majority of cases are malignant granulocytes w/ Philadelphia chromosome
Presentation: high granulocyte count on CBC, splenomegaly.
S/S: fatigue, weight loss, sweats, bleeding, abdominal discomfort (spleen)
Age: 40-50yrs
Treatment: Standard Chemo only produces temporary remission. Untreated survival rate of 2 years. ONLY CURE: is allogenic stem cell transplant, even with this about 50% cure rate. If progresses to blast crisis (increase in immature cells), prognosis very poor
Acute Lymphoid Leukemia: ALL
Cause: 80% are B-cell in origin, 20% T-cell
Presentation: Multiple genetic subtypes
At least 20% of bone marrow cells must be blasts for ALL diagnosis
Crowd out other normally functioning cells in bone marrow
S/S: abrupt onset of bone pain, bruising, fever, infection, loss of appetite. May see enlarged liver, lymph nodes, spleen.
Age: Peak incidence 3-7y/o, with second smaller peak in middle age
Treatment: Very curable in children (85%), but lower survival in adults (30-50%)
Cyclical chemotherapy administration
Will need chemo to continue for several years after remission is achieved
If recurs, can do stem cell transplant
Chronic Lymphoid Leukemia: CLL
30% of all adult leukemia cases.
Cause: 95% of cases due to a malignant B-cell precursor;
T-cell cases more aggressive and harder to treat.
Presentation: Often found by accident on routine CBC because remains asymptomatic for long period
S/S: fatigue, weight loss, anorexia. Leukemic B-cells do not produce antibodies normally, so increased infections.
Age: Depending on genetics and subtype, can have survival up to 24 years
Treatment: May not treat since so many live with manageable symptoms and the disease is slow progressing.
May consider stem cell transplant-weigh risks and benefits
Multiple myeloma
AKA cancer of plasma cells.
The plasma cells are a type of white blood cell in the bone marrow. With this condition, a group of plasma cells becomes cancerous and multiplies. The disease can damage the bones, immune system, kidneys, and red blood cell count
Cell Responsible: Plasma Cells
Malignant disorder of mature, antibody secreting B-cells (called plasma cells).
Can invade bone, spleen, liver, kidneys, lymph nodes and form multiple tumors
Excessive production of antibodies of a single type
Accumulation of antibody fragments in blood and urine (called Bence Jones proteins in urine), can cause kidney damage.
Also cause bone lesions with pathologic fractures
S/S: many due to bone and renal damage; hypercalcemia. As progresses, other symptoms from bone marrow crowding
Treatment: antineoplastics, survival about 3 years. May do stem cell transplant
Age: Median age of presentation is 65, and more common in men
Hodgkin Disease
Cell Responsible: Malignant disorder of lymph nodes, presence of Reed-Sternberg cells (originate from B-cells in the germinal centers of lymph nodes)
Metastasize pattern is very predictable
½ of cases between 20-40 y/o, more common and more severe in males
Manifestations: painless lymph node enlargement (usually above diaphragm), fever, night sweats, weight loss, malaise
Treatment: includes radiation, often in combo with antineoplastics.
5-year survival for treated disease is 85%
Non-Hodgkin Lymphoma
All other lymphomas that do not have Reed-Sternberg cells.
S/S is similar to Hodgkin disease but spreads much quicks and less predictable
Most occur in older adults, males slightly higher risk, increased risk in AIDS
5-year survival with treatment 50%, as patients often do not present until disease is advanced.
