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Internal Medicine pt. 2 > Leukemia > Flashcards

Leukemia Flashcards

1
Q

What is the classification of leukemia?

A

immature cells that are high in number & non functioning

  • acute myeloid leukemia
  • acute lymphoid leukemia

mature cells that are high in number

  • chronic myeloid leukemia
  • chronic lymphoid leukemia
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2
Q

What are the causes of leukemia?

A 
1- irradiation 
2- chemicals & drugs 
- chloramphenicol 
- alkalytion agents 
- benzene 
3- genetic factors -> philadelphia chromosome 
- in chronic myelocytic leukemia (huge spleen) 
4- infections -> EBV
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3
Q

What is the clinical picture of all types of leukemia?

A

1- Fever -> infections, high cell turnover, & release of pyrogens
2- Retina -> scotoma & hemorrhages
3- CVS -> hemorrhagic pericardial effusion & leukostasis hypoperfusion
4- Respiratory -> hemorrhagic pleural effusion & pulmonary infiltrate
5- RES -> splenomegaly & hepatomegaly & LN enlargement
6- GIT -> diarrhea, hemorrhage, pain, & salivary gland enlargement
7- Kidney -> uric acid stones & infections
8- Bone -> bone pain at sternum & gout
9- CNS infiltration

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4
Q

What are the signs of CNS infiltration in leukemia?

A
  • aseptic meningitis
  • focal lesion
  • cranial nerve palsy
  • spinal compression
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5
Q

What are the effects of LN enlargement in leukemia?

A
  • mediastinal syndrome
  • obstructive jaundice (porta hepatis)
  • masses found anywhere
  • compression of ureters -> hydrometer & hydronephrosis
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6
Q

What is the cause of gout & uric acid stones inn leukemia?

A

high cell turnover will cause an increase in purines

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7
Q

What will be seen on bone marrow biopsy in leukemia?

A

Anemia

  • BM infiltration -> aplastic anemia
  • decreased B12 & folic acid -> megaloblastic anemia
  • hemorrhage -> iron-deficiency anemia
  • splenomegaly -> hemolytic anemia

Thrombocytopenia

  • BM infiltration
  • splenomegaly
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8
Q

What will be found on blood picture of acute leukemia?

A

Anemia

  • aplastic anemia due to bone marrow infiltration (most common)
  • megaloblastic or microcytic hypochromic (if complicated)

Thrombocytopenia

  • increased bleeding time
    • Hess capillary test
  • decreased platelet count
  • normal clotting time, PT, PTT

WBCs
- marked increase in blast cells >25 000 (n=4000-11000)

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9
Q

What are the variants of leukemia that require a bone marrow biopsy to be taken?

A

Subleukemic form

  • normal total leukocytic count
  • blast cells in the blood >5%

Aleukemic form

  • normal TLC
  • no blast cells in the blood only in the BM

bone marrow biopsy will reveal >20-30% blast cells

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10
Q

What is the difference between ALL & AML?

A

ALL AML

  • small - large
  • no granules - granules
  • no peroxidase - peroxidase
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11
Q

What are the investigations that should be done for leukemia?

A

1- blood picture
2- BM biopsy
3- investigations for organ infiltration (according to the presenting symptoms)
4- chemistry -> increased LDH, uric acid, & K

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12
Q

How is acute leukemia treated?

A 
1- supportive measures 
- blood transfusion to keep Hb >8
- platelet transfusion for thrombocytopenia
- antibiotics & gamma globulins 
- allopurinol for uric acid 
- leukopharesis for leukostasis 
2- monoclonal antibodies 
3- chemotherapy -> prednisone 
4- bone marrow transplantation if < 40 years
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13
Q

What is the aim of chemotherapy in acute leukemia?

A

Induction of remission known if

  • no clinical manifestation
  • no blast cells
  • platelets >75000
  • PMLs >5000

CNS prophylaxis

  • radio-spinal irradiation -> if CSF is +
  • methotrexate + floc acid -> if CSF is -

Consolidation therapy
- high doses for 4 weeks to attack residual disease

Maintenance therapy
- methotrexate + folic acid for 2 years

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14
Q

What is the clinical picture of chronic myelocytic leukemia?

A
  • middle age (50-60)
  • huge spleen -> dragging pain
  • splenic infarction -> stitching pain
  • hepatomegaly
  • bone pain & tenderness in sternum
  • infiltrative manifestations
  • Blastic crises -> transformation to acute
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15
Q

What is seen in blood picture of chronic myelocytic anemia?

A
  • RBCs increase initially then anemia
  • platelets increase initially then thrombocytopenia
  • WBCs 100 000 - 500 000 mainly myelocytes -> no risk of infection because cells are mature
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16
Q

What is seen on bone marrow biopsy of chronic myelocytic leukemia?

A

hypercellular & increased granulocyte precursors

main cause is philadelphia chromosome mutation -> chromosome 22 translocated with 9

17
Q

How is chronic myelocytic leukemia treated?

A 
1- supportive 
2- monoclonal antibodies 
3- chemotherapy 
- bulsulphan 
- a-interferon 
- hydroxyurea 
4- radiotherapy 
5- bone marrow transplant in < 60 years 
6- treat plastic crises like AML & ALL
18
Q

What is the clinical picture of chronic lymphocytic leukemia?

A
  • occurs in old age > 50
  • lymphadenopathy is the most characteristic feature -> pressure manifestations depending on location
  • more infections -> due to abnormal B cell accumulation & abnormal Ig response
  • autoimmune hemolytic anemia & autoimmune thrombocytopenia -> due to abnormal Igs
19
Q

What are the investigations made for chronic lymphocytic leukemia?

A

1- blood picture
- autoimmune hemolytic anemia
- autoimmune thrombocytopenia
- splenic sequestration
- WBCs 50 000- 25 000 with absolute lymphocytosis
2- BM aspiration -> infiltrated by lymphocytes
3- LN biopsy -> destroyed architecture & replaced by lymphocytes
4- chemistry -> increased LDH, uric acid, & gammaglobulins

20
Q

How is chronic lymphocytic leukemia treated?

A 
1- supportive 
2- monoclonal antibodies 
3- chemotherapy -> chlorambucil & corticosteroids (for autoimmune disease) 
4- radiotherapy -> for LN & spleen 
5- BM transplant in patients < 50 years
21
Q

What are the causes of huge spleen?

A

1- inflammatory -> malaria, bilharziasis, kala-azar
2- congestive -> severe portal hypertension
3- hematological -> Thallassemia major, CML, polycythemia vera, lymphoma
4- infiltrative -> amyloidosis & Guacher’s
5- collagen -> sarcoidosis & Felty syndrome

Internal Medicine pt. 2 (19 decks)

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