Hilgerson 1/2 Flashcards
Acute Myelogenous leukemia (AML)***
- 80% of acute leukemias in adults
- over age of 60
Etiologys of AML
- Ionizing radiation (atomic bomb survivors, prior radiation therapy)
- benzene
- increased incidence with Down’s patients
- myeloproliferative or myelodysplastic syndromes
- chemotherapy can cause tx related AML
typical clinical presentation of AML***
-
Malaise, pallor, weight loss, fever and BLEEDING (not hyperviscosity/thrombotic problems)
- bleeding via nosebleeds, melana, hematuria, purpura
those with treated AML die of..***
INFECTION
hemorrhage from thombocytopenia
What is a morphologic indication of AML**
- AUER RODS ON PERIPHERAL SMEAR
Acute lymphoblastic leukemia epidemiology***
- 20% of adults leukemias
- primarily a disease of kids (75% of patients < 15)
Etiology of ALL
- ionizing radiation
- increase incidence with down’s patients
clinical presentaiton of ALL**
- Similar to AML
- malaise, pallor, weight loss, fever and BLEEDING!!!
- CNS meningeal involvement (more often in ALL) may produce stiff neck, papilledema and cranial nerve involvement
What phsyical findings are more common in ALL than in AML**
- lymphadenopathy occurs in > 50% of ALL
- uncommon in AML
- Hepatosplenomegaly > 2/3rds of ALL
- hepatomegally uncomoin in AML
prognosis of ALL**
better in children
much WORSE IN INFANTS AND ADULTS
Myeloproliferative syndromes tend to have what..
BASOPHILIA tends to occur in ALL of the myeloproliferative syndromes
Chronic Myelogenous leukemia (CML) serology/cytogenetics
- leukocytosis (sometimes 50 to 600K
- Increased basophils, eosinphils and nucleated RBC
- low leukocyte alkaline phosphatase
- > 30% blasts in peripheral blood or marrow is the strict defintiion of a BLAST CRISIS
CYTOGENETICS
- PHILADELPHIA CHROMOSOME –> CML!!! (t(9,22) or bcr-abl oncogene)
CML presentation (actie phase)
- lethargy, weight loss, increasing abdomen girth, sweating, easy brusing/bleeding HEPATO-SPLENOGEALLY
- Diagnose = t(9,22); Ph(+) xome; LOW LEUK ALK PHOS
What are some compliactions of CML
- almost inevitably become BLASTIC and converts to ACUTE LEUKEMIA (80% AML, 20% are ALL)
Polycythemia vera general
- Hb and Hct ABOVE NORMAL
- relative polycthemia = caused by dehydration from GI loss or insensible fluid loss
primary and secondary erythropoietin
- Primary
- Erythropoietin (AKA EPO) = independent Red blood cell production (low EPO = PCV)
- Secondary
- exogenous EPO admin
- excessive EPO production
- tissue hypoxia (high altitude, pulm dz, sleep apnea)
- Autonomous secretion from selected tumors
PCV clinical presentation
- patietn is typically older
- INTENSE PRURITIS AFTER BATHING
- patients appear plethoric; RUDDY complexion; SPLENOMEGALY
- Serology: classically elevated Hgb/Hct, elevated RBC mass
TX of PCV
- Periodic phblebotomy (goal Hct <45%)
Chronic Idiopathic Myelofibrosis
(aka myelofibrosis with myeloid metaplasia , MMM)
- “tear drop” RBCs –> seen in all disease which infiltrate the BM, but especially striking numbers in MMM
- characteristic DRY TAP due to increased collagen and reticulin fibers
Essential thrombocythemia
- platelets = 600K to 4 million
- better defintion: myeloproliferative disorder with persistent thrombocytosis
complications of thombocythemia
- THROMBOSIS (occur most often)
- cloths
- Hemorrhage (includes epistaxis, GI bleeding)
- dont function properly
- Splenomegaly
- filter for all blood cells
essential diagnosis of thrombocythemia
- Plt count > 600K
- megakaryocytic hyperplasia
- splenomegaly
- absence of Ph(+) xome –> rule out ALL
- normal RBC mass –> rule out stuff
- Exclusion of all causes of reactive thrombocytosis
- stainable iron in marrow
