Leukemia Flashcards
how do you calculate the absolute neutrophil count
- ANC= WBC X total neutrophils
what is a normal ANC
- > 1000
- usu 1500- 8000
what is a neutropenic ANC
- 500-1000
what is severe neutrophenia
- chronically < 500
what is the role of neutrophils
- fight bacterial infections
indications for bone marrow bx
- pt specific i.e. unexplained anemia
- pancytopenia
- abnormal cells in circulation
contraindcations for bone marrow bx
- hemophilia
- severe DIC
- other severe bleeding disorders
things that are NOT contraindications to bone marrow bx
- thrombocytopenia
- therapeutic anticoagulation
sites for bone marrow aspiration
- posterior superior iliac crest and spine*
- anterior iliac crest
- greater troch
- vertebral bodies or ribs
- sternum- usu C/I
- tibia in kids < 12-18 mo
what causes leukemia
- too many progenitor cells produced in bone marrow
- abnormal cells dont die when they should
- overproduction of bad cells interferes with prod of good cells
- cells accumulate and occupy space -> leukostasis
how do you categorize leukemias
- lymphoid vs myeloid cells
- acute vs chronic
what is the blast cell count in leukemia
- > 20%
what is the blast cell count in myelodysplastic syndrome
- < 20%
what type of leukemia is most common in kids
- ALL
what type of leukemia is most common in adults
- AML
what are myelodysplastic syndromes
- bone marrow does not make enough good cells
- make immature cells < 20%
- may present with initial low grade anemia
types of myelodysplastic syndromes
- refractory anemia
- refractory cytpopenia with multilineage dysplasia
- refractory anemia with ringed sideroblasts
- refractory cytopenia with multilineage dysplasia and ringed sideroblasts
- refractory anemia with excess blasts
risk factors for myelodysplastic sydromes
- age*- rarely in pts < 60
- smoking
- long term exposure to chemicals
- radiation
- inherited disorders
inherited disorders that cause myelodysplastic syndromes
- fanconi anemia
- shwahmann diamond syndromes
- familial platelet disorder
- severe congenital neutropenia
acute myelogenous leukemia (AML)
- rapid accum of immature meyloid cells
- accum in bone marrow -> interfere with other production lines
- increased incidence with age
risk factors for AML
- genetics- trisomy 21, fanconi
- chemicals
- high dose radiation
- drugs- alkylating agents, topoisomerase II inhibitors, chloramphenicol, phenylbutazone
si/sx of AML
- can be gradual or abrupt
- fatigue
- anorexia, weight loss
- fever +/- infx
- bleeding, easy bruising
- HA
PE findings for AML
- fever
- splenomegaly
- LAD
- sternal tenderness
- ecchymosis, petechiae
- papilledema
- CN abnormalities
- gum hypertrophy
- skin infiltrates
- bone pain
work up for AML
- auer rods on smear*
- bone marrow bx and aspirate*
- LP if suspect CNS involvement
- immunophenotyping
- cytogenetics