Hubbard 1 CIS Flashcards
causes of leukocytosis
- benign causes more common than malignant causes!!
- anything that can cause inflammation can cause leukocytosis!
- drugs!!! (glucocorticoids)
pts who smoke might have what?
neutrophilia
causes of neutropenia
- benign causes much more common than malignant
- infections, esp viruses
- drugs!!
neutropenia- other causes?
- medications
- nutritional deficiencies
- sequestration
old person marrow
-takes longer for bone marrow to release white cells
acute and chronic leukemia
- acute- immature precursor cells (blast cells)
- chronic- more mature appearing cells
Leukemia- etiology
- toxins, drugs, chemicals
- benzene- AML!!
- treatment-related AML (pts who received chemotherapy for other cancers)
- alkylators!!
- radiation (except CLL)
- virus-mediated chromosomal alterations
- hereditary dz
- myelodysplastic syndromes
older pts with mild pancytopenia and macrocytosis- dx?
-myelodysplasia or early AML!!
philadelphia chromosome
- major genesis- chromosomal damage
- CML
- chrom 9 and 22 translocation
cornerstone dx in all leukemias
-chromosomal studies (cytogenetics)
acute leukemia- clinical presentation
- rapid onset
- if untreated- median survival is <3 months
chronic leukemia- clinical presentation
- very slow onset, chronic course
- 1/2 of pts with CLL are still alive and have not required tx 6 yrs after dx
leukemia- presentation
- fever, easy bruising, fatigue, weight loss, SOB
- acute leukemias- bone pain
- chronic- usually asymptomatic
Sweet’s syndrome
(AFND- acute febrile neutrophilic dermatosis)
- cutaneous manifestation of AML
- bx shows myeloblasts in dermis
- tx- management of AML
Auer rods
- azurophilic rods in cytoplasm in pts with AML
- resemble a bundle of sticks (fagot cells)
gingival hypetrophy
-most common in M4 and M5 variants (monocytic) variants of AML
smudge cells
-in CLL
DIC in what pt? tx? cytogenetic?
acute promyelocytic leukemia
- fibrinogen low, D-dimer elevated
- tx- ATRA (all-trans retinoic acid)
- t(15;17)
leptomeningeal carcinomatosis- in who? cytogenetic? tx?
- in 30% of pts with ALL- diplopia is a sx
- t(4;11)
- intrathecal methotrexate!!
AML- M1 and M2- cytogenetics
-t8;21
myelodysplastic syndrome- cytogenetics
- trisomy 8
- 7q-
- inversion 16
how to evaluate a lymphoproliferative disorder
-peripheral blood lymphocyte flow cytometry
TRAP stain of peripheral blood lymphocytes- used for?
-HAIRY cell leukemia!
RAI stage- (for CLL)- peripheral blood flow cytometry
- 0- lymphocytosis
- 1- plus lymphadenopathy
- 2- plus hepatosplenomegaly
- 3- plus anemia (Hg < 11)
- 4- plus thrombocytopenia (platelets < 100,000)
CLL- tx?
-observation (if indolent- may never require tx
lymphoma- clinical pearls
- LNs are non-tender, rubbery
- pain in LNs after beer drinking (in HL)
- back pain, leg edema- suggest retroperitoneal LN enlargement
Richter’s syndrome
- CLL- develops into diffuse large B-cell lymphoma
- tough to kill
B symptoms
- fever, drenching night sweats, 10% weight loss in last 6 months
- likely paraneoplastic
- worse prognosis
inc risk for primary CNS lymphoma?
-immunosuppressed pts
lymphomas can be linked to an infectious agent
- EBV- HD, Burkitt
- H pylori- gastric MALT lymphoma
cervical adenopathy- consider?
-infection, lymphoma, unusual disorders (Kikuchi dz, TB)
Hodgkin lymphoma- tx?
- early stage- radiation
- late stage- chemotherapy
Burkitt lymphoma- cytogenetifsc
t8;22
Ann Arbor stage (for lymphomas)
- 1A- 1 LN on 1 side of diaphragm
- IIA- 2 noncontiguous LNs on 1 side of diaphragm
- IIIA- both sides of diaphragm
- IVA- mult sites on both sides of diaphragm OR bone marrow involvement!
