Leukemias ☺️ Flashcards
Pathophysiology of leukemias
- acute
- chronic
Clone of malignant cells at any stage of maturation in BM => accumulation of abnormal cells
- cannot be released from the bone marrow
- less space to make functional WBCs, RBCs, platelets
- abnormal cells spill into blood
- fewer functional cells made => pancytopenia
Acute - from immature cells
-rapid progression
Chronic - from mature cells
-slow progression
Epidemiology and prognosis of
- AML (acute myeloid)
- ALL (acute lymphocytic)
- CML (chronic myeloid)
- CLL (chronic lymphocytic)
AML - more common in adults
-primary disease or progression fro MPD
ALL- MOST COMMON IN CHILDREN, some adults
-cure rate in children high, lower in adults
CML - adults
- can accelerate into acute
- Philadelphia chromosome 9 22 translocation
CLL- MOST COMMON IN ADULTS
-extremely slow progression
Presentations of leukemias
Fever, nightsweats, weightloss, lymphadenopathy, bone/joint pain
Pancytopenia
Anemia => fatigue, lightheaded, splenomegaly, hepatomegaly
Neutropenia => frequent infections, sore throat, moth, fever
Thrombopenia => easy bruising, bleeding gums, nosebleeds, petichiae
Investigations
FBC Blood film Bone marrow aspiration Genetic testing Immunological testing Cytogenetic testing
Investigation findings for
- ALL
- AML
- CLL
- CML
ALL - high lymphocytes
AML - low mature myeloid cell line
CLL - high lymphocytes
CML - high mature myeloid cell line
Management of leukemias
-supportive
Blood, platelet transfusions
IV fluids
Allopurinol - prevent TLS
Neutropenia regimen
- avoid IM injections
- FBC, platelets, INR, U&E, LFT< LDH, CRP
- urine, stool sample
Prophylactic antivirals, antifungals, ABx
Management of leukemias
-definitive
Chemo, RT
Allogenic BM transplants
Risk factors for leukemia
Exposure to high dose radiation, benzene SMOKING Radiotherapy, chemotherapy MDS Genetics, FHx
