Leukemias and Myeloproliferative Disorders Flashcards
What are blast indicative of?
AML or ALL
What are band indicative of?
infection
What if neutrophils are high and lymphs are low with no abnormal cells
corticosteroids
Causes of polycythemia
- dehydration
- tobacco abuse
- Pickwickian
- JAK2 mutation
- High erythropoetin levels
Myeloproliferative neoplasms vs Myelodysplastic Syndrome
MPN: too much blood
MDS: not enough blood, cytopenias, and BM hyperplasia
–>As dysplasia increases, the less functional blood is made
Chronic myeloproliferative neoplasms
- Chronic myeloid leukemia (CML)
2. Polycythemia vera
Polycytemia: primary versus secondary
primary: acquired or inherited mutation
Ex. polycythemia vera
secondary: due to elevated EPO
Ex. Hypoxia, EPO secreting tumor like RCC
combined: due to decreased plasma volume and increased RBC mass
Ex. tobacco use
Which mutation is associated with Polycythemia vera?
JAK2 mutation
Dx: BM bx
- hypercellular (increased RBC mass, high hematocrit)
- absent Fe stores
- Epo is low
Polycythemia vera: presentation/labs
- pruritis following a warm bath**
- Erythromelalgia of hands/feet (burning, redness, warmth)
- Facial plethora
- splenomegaly
labs:
Hgb ~18 (lil high)
Polycythemia vera: treatment
- phlebotomy (goal is Hct <45%)
- ASA, low dose
Essential Thrombocythemia
Median platelet count is >1,000,000 (>450,000 is abnormal)
BM bx: megakaryocytes are prominent and in clusters
Tx:
- ASA, low dose
- Hydroxyurea (if med to high risk)
Chronic Myeloid Leukemia
- Philadelphia chromosome**
- WBC (100-200K)
- Blast phase (or blast crisis) with either lymphoid blasts, or myeloid blasts.**
CML: labs
- HIGH WBC
- Bone marrow biopsy (strongly recommended)
CML: treatment
Cure:
allogenic stem cell transplant
Disease control:
Imatinib (Gleevec)
tyrosine kinase inhibitors
Palliative therapy
Hydroxyurea
Can all myeloproliferative neoplasms and myelodysplastic syndromes transform to acute leukemia?
yes
-worse prognosis if leukemia arises from these
Acute Myelogenous Leukemia (AML)
-older patients
-Auer rods**
Tx: allogenic stem cell transplant
Acute Lymphoblastic Leukemia (ALL)
- mostly affects kids (3-7 years)
- higher incidence of CNS involvement
Tx: chemotherapy (danurubicin, vincristin, prednisone, asparginase)
Similarities of AML and ALL
- pancytopenia with circulating immature cells (blasts)
- MARKED leukocytosis >200K*
Chronic Lymphocytic Leukemia (CLL)
- Malignancy of mature B lymphocytes
- MC lymphoid leukemia in adults*
-SMUDGE CELLS*
CBC: elevated WBC with lymphocytosis
Aplastic Anemia
Causes: drugs (chloramphenicol [antibiotic], benzene, toluene), radiation, infection, or inherited (Ex. Fanconi anemia)
Signs/Sx:
- pallor
- purpura, petechiae
- NO spleen enlargement
Tx:
Allogenic stem cell transplant
Hairy cell leukemia
- Men*
- Middle age
Signs/Sx:
-palpable spleen**
labs:
-pancytopenia (low RBC, WBC, platelet)
peripheral smear:
hairy b cells**
LAP score
=leukocyte alkaine phosphatase
-This is ordered when WBC is elevated and want to differentiate reactive process from CML
IF LAP score is low –> CML
