Leukemia

Question 1

Etiology of leukemias

Answer 1

1-Genetic theory: identical twins have higher incidence , CML has an abnormality in a gene , more common in down$ and klienfelter
2-Chemicals : benzene industry
3-Ionizing radiation: more common in patients that encountered it
4-Alkalyting agents : Chlorambucil causing myeliod leukemia
5- Immune deficiency
6- Viruses : HTLV 1 - T cell lymphotropic virus ( retro virus causing T cell leukemia)

Question 2

Clinical picture of acute leukemia

Answer 2

Manifestations of BM failure: Infection( fever; neutropenia) , Anemia , Bleeding
Manifestations of organ infiltration:
1-Bone( sternum tenderness and pathological fractures)
2- Liver , spleen , Lymphadenopathy ( common in ALL , 30% AML )
3-Skin ( leukemia cutis) , 4-CNS ( headache , cranial nerve paralysis)
5-Retina( diminished vision) 6- Porta hepatis ( obstructive jaundice)
7-Membranes: effusions 8- Lung; hemoptysis 9-Heart; cardiomyopathy
10-Kidney : tubular disorder ; Hyponatremia and hypokalemia
11-Leukostasis: occlusion of the microcirculation ( brain , lung , penis (priapism) with high blast count

Question 3

Investigation for acute leukemia

Answer 3

1-TLC count can be 25% >50,000mm3 , 50% 5,000-50,000mm3 , 25% <5,000mm3 , most cases have blasts in the peripheral blood but can be absent or low
2- Normocytic normochromic anemia
3-Thrombocytopenia 4- Very high ESR
5- B.M examination: blast cells 20-30% > is diagnostic of acute leukemia ; B.M biopsy used for cytology , cytochemistry and immunohistochemistry will differentiate between AML and ALL
( presence of Auer rods diagnostic of AML)
6-Inv for uric acid , LDH , renal , hepatic profiles, brain CT and pelviabdominal sonar

Question 4

DD of acute leukemia

Answer 4

1- Infectious mononucleosis ; fever with sore throar
2- other causes of anemia and thrombocytopenia
3- causes of leukemoid picture 4- causes of lymphadenopathy

Question 5

General supportive measure for acute leukemia

Answer 5

1- Anemia ( 8-10 gm/dl)
2- Bleeding plts (8000-10,000)
3- Infections <500 mm3 pnls
-Antibiotics for gram negative , gamma globulin , granulocyte transfusion
-Antifungal: sutrim for pneumocystis carnii
-Viral acylvoir for hsv , ganclvoir for cmv
4-Hyperuricemia (tumour lysis $) : Allopurinol , alkaline urine , hydration
5- Phosphate binders: calcium carbonate and acetate
6- Leukostasis: leukopharesis