Hematologic Malignancy Overview Flashcards
Iron deficiency anemia
MCV always low
Iron is always low
Hemocrit and hemoglobin is always low
- usually caused by bleeding in the 1st world, whereas in the 3rd world it can be diet related
- in men in the 1st world or postmenupausal women, iron deficiency anemia is always colo-rectal cancer until proven otherwise*
Myelodysplastic syndrome (MDS)
Hyper cellular marrow is always present
MCV is usually high (megaloblastic)
Prognosis Varies
Pancytoplasia and dysplasia is always present
Can have multiple chromosomal abnormalities
Blasts always don’t increase past 5% (if it does then it is leukemia, not MDS)
- only cure is an bone marrow allotransplant*
- if cant cure, transfusions support with light chemo is treatment
incidental Thrombocytopenia
Is not always a pathological issues (100-150 can be normal variant)
- under 100 is usually a pathological issue
If feels healthy, probably healthy
Immune thrombocytopenia (ITP)
Always less than 100 platelets and ONLY lowers platelet counts
- diagnosis of exclusion
Goal of therapy is to prevent bleeding, not curing the patients (not cost efficient)
If needing to up platelets levels, prednisone is 1st line followed by rituximab
Chronic lymphoid leukemia
Diagnosed via flow cytometry and blood smears
- smears show high lymphocytes and smudge cells
- flow cytometry show low levels of normal mature B-cells and high levels of immature B0-cells
- the B-cells are large and symmetrical clones in histology slides
Cytogenetics determines prognosis of CLL
- best case = 13q deletion
- worst case 17p deletion
Often does not have to be treated, only treat if
- fever, night sweats, weight loss
- Thrombocytopenia/ anemia develops secondary
- painful/bothersome adenopathy
many treatment options if needed
Chronic Myeloid leukemia
Always produces the Philadelphia chromosome t(9;22) fusion
- always produces BCR-ABL tyrosine kinase proteins
Always produces splenomegaly
- usually presents with stupid high WBCs (w/ basophil and eosinophil high), slightly high platelets and normal hemoglobin
Produces a wide variety of different looking cells (implies myeloid linage)
Survival is based on phase (determined by levels of myeloid blast cells)
- blastic phase is most deadly
- chronic phase is safest
Imatinib is the 1st line of treatment, needs to start immediatelyand makes the disease not deadly (although doesn’t cure persay and requires lifetime use)
Acute Myeloid Leukemia
Diagnosed via flow cytometry showing high CD45 , CD4 and CD7 markers.
Cytogenetics show a deletion of chromosomes 16
Deadly, usually needs cell transplant to “cure”
Induction Treatment = 7+3 days
- 7 days of area-C + 3 days of anthracycline
Consolidation treatment
- can also do allogeneic stem cell transplant for very severe cases
Age 60+ most common (60%)
Acute Promyelocytic leukemia (APL)
Subset of AML (10%)
Presents with petechiae, super high blastocyte levels,
WBC and platelets are super low,
INR and fibrinogen is super low
Cell staining shows myelocytes
Immediate treatment needed and 10% of patients due from brain/GI hemorrhage
- also produces w/ DIC
Always present with t(15;17) fusion with PML/RAR protein
Treated with ATRA (all-trans retinoic acid) and arsenic
Acute lymphoblastic leukemia (ALL)
Always presents with enlarged lymph nodes
Always presents with high number of lymphoblastic cells
More common in children with higher curable rates
Adults more difficult to treat
Requires LOTS of chemo to get into remission with stem cell transplant to cure.
Hodgkin lymphoma
Presents with Reed-Steinberg cells (RS)
Very curable if caught early treated with ABVD cycles
Monocolonal gammopathy of undermined significance (MGUS)
Often noted when doing an SPEP
(Serum protein electrophoresis)
Shows note-worth gamma globulins, but not stupid high levels like multiple myeloma
- can be a precursor to multiple myeloma though
Clinical manifestations are:
- calcium abnormalities
- renal insufficiency
- Anemia
- Bone lesions
