Leukemia Flashcards
Leukemia
malignant transformation of WBCs. Myeloid or lymphoid
acute leukemia versus chronic leukemia
acute- immature
chronic- mature
acute lymphoblastic/ lymphocytic leukemia
rapid proliferation of immature lymphocytes
occurs primarily in children
young children, ages 2-5
whites
MC cancer in children Down syndrome (we ALL fall Down)
H and P bone pain frequent infections anemia (fatigue, dyspnea on exertion, pallor, thrombocytopenia) lymphadenopathy hepatosplenomegaly
PBS: abundant blasts
PAS and TdT positive
Philadelphia chromosome t[9;22], found in 15% of adult ALL cases
Treatment: Imatinib, targets Philadelphia chromosome tumors
chronic myelogenous leukemia
proliferation of mature granuloctytes
midlife, can be associated with radiation exposure
feared complication: blast crisis
mature myeloid cells transform into immature blasts, thus blast crisis can be fatal
H and P:
possibly asymptomatic
fatigue
weightloss, nightsweats, hepatosplenomegaly
Labs:
no smudge cells
very high WBC
increasd myeloid precursors (promyelocytes, myelocytes, and metamyelocytes)
Philadelphia chromosome
almost always CML
(t[9;22] BCR-ABL, which is an oncogene tyrosine kinase always switched on)
Treatment:
imatinib
Acute myelogenous leukemia
Proliferation of immature myeloid cells
20% are blast
fatigue, easy bruising, frequent infections, unlike ALL you DO NOT see a lot of bone pain
Bone marrow biopsy shows blasts (myeloid cell line)
Myeloperoxidase positive
PBS:
Auer rods in the cytoplasm of blasts
notched nuclei
Chronic lymphocytic leukemia
mature B cells
elderly patients
H and P: similar to Hodgkin lymphoma fatigue frequent infections night sweats fevers lymphadenopathy hepatosplenomegaly may be asymptomatic
Labs: increased WBC (>100,000)
Bone marrow biopsy:
mature lymphs filling up the marrow space
slides: Smudge cells (lymphocytes tear apart when you put them on a glass slide)
Hairy cell leukemia
looks hairy
better prognosis than CML
fatigue frequent infections abdominal fullness massive splenomegaly no lymphadenopathy
Myelodysplastic syndrome
ineffective production of WBCs
pre-leukemic state (could progress to cancer)
keep a close eye on these
typically, hypogranulated PMNs and
hyperlobular granulocytes with nuclei
Anemia (macrocytosis)
Polycythemia vera is a type
The pseudo-Pelger-Huet anomaly:
PMNs have nuclei with 2 lobes connected by a thin strand
Treatment: monitor for progression Transfusions Growth factors Stem cell transplant
Oncology therapy
Surgery
Radiation
Chemotherapy
Most common neoplasm in children
ALL
most common leukemia in adults
CLL
Philadelphia chromosome is almost always seen
CML
Smudge cells on peripheral smear
CLL
Peripheral blasts are PAS+ and TdT+
ALL
Peripheral blasts are PAS-, myeloperoxidase +, and have Auer rods
AML
