Leukemia Flashcards
What is the classification of leukemia?
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
What are the causes of leukemia?
1- irradiation 2- chemicals & drugs - chloramphenicol - alkalytion agents - benzene 3- genetic factors -> philadelphia chromosome - in chronic myelocytic leukemia (huge spleen) 4- infections -> EBV
What is the clinical picture of all types of leukemia?
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
What are the signs of CNS infiltration in leukemia?
- aseptic meningitis
- focal lesion
- cranial nerve palsy
- spinal compression
What are the effects of LN enlargement in leukemia?
- mediastinal syndrome
- obstructive jaundice (porta hepatis)
- masses found anywhere
- compression of ureters -> hydrometer & hydronephrosis
What is the cause of gout & uric acid stones inn leukemia?
high cell turnover will cause an increase in purines
What will be seen on bone marrow biopsy in leukemia?
Anemia
- BM infiltration -> aplastic anemia
- decreased B12 & folic acid -> megaloblastic anemia
- hemorrhage -> iron-deficiency anemia
- splenomegaly -> hemolytic anemia
Thrombocytopenia
- BM infiltration
- splenomegaly
What will be found on blood picture of acute leukemia?
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)
What are the variants of leukemia that require a bone marrow biopsy to be taken?
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
What is the difference between ALL & AML?
ALL AML
- small - large
- no granules - granules
- no peroxidase - peroxidase
What are the investigations that should be done for leukemia?
1- blood picture
2- BM biopsy
3- investigations for organ infiltration (according to the presenting symptoms)
4- chemistry -> increased LDH, uric acid, & K
How is acute leukemia treated?
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
What is the aim of chemotherapy in acute leukemia?
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
What is the clinical picture of chronic myelocytic leukemia?
- 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
What is seen in blood picture of chronic myelocytic anemia?
- 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
What is seen on bone marrow biopsy of chronic myelocytic leukemia?
hypercellular & increased granulocyte precursors
main cause is philadelphia chromosome mutation -> chromosome 22 translocated with 9
How is chronic myelocytic leukemia treated?
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
What is the clinical picture of chronic lymphocytic leukemia?
- 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
What are the investigations made for chronic lymphocytic leukemia?
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
How is chronic lymphocytic leukemia treated?
1- supportive 2- monoclonal antibodies 3- chemotherapy -> chlorambucil & corticosteroids (for autoimmune disease) 4- radiotherapy -> for LN & spleen 5- BM transplant in patients < 50 years
What are the causes of huge spleen?
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
