Leukocyte Disorders Clinical Presentation

Question 1

Acute Lymphoblastic Leukemia ALL

Answer 1

• Fever of unknown origin - MC presenting symptom
• Related to bone marrow infiltration
• neutropenia
• secondary infections most often seen with ANC < 500/µL; severe infection with < 100/µL, recurrent infections, had pneumonia 3 times in the last 6 weeks for example
• anemia
• fatigue, dizziness, palpitations, exertional dyspnea, pallor
• thrombocytopenia
• petechiae, ecchymosis, occult and gross blood loss
• Related to organ infiltration
• lymphadenopathy
• bone pain – the crowding the in bone marrow build up pressure in the marrow. Like a water balloon that wants to pop. Patients say leg hurts worse at night, deep aching pain.
• LUQ abdominal fullness, early satiety “I get full quickly”. For a kid’s parents – “He doesn’t eat good”. Ask, HOW are they eating? Reduced appetite? Can also see weight loss. Kid will say “my belly hurts” (splenomegaly).
• mediastinal mass pushes on esophagus, feel like they can’t take a deep breath.
• chest pain, dysphagia, or dyspnea (do you feel like you just ran a race or you can’t take a deep breath?)
• swelling of the neck (if mass pressing on vascular structures, red blood has nowhere to go but superiorly), face, and upper limbs
• painless testicular swelling/mass (females ovary not so much)
• Leukostasis (aka hyperleukocytosis) - WBC > 100,000/μL - leads to inadequate circulation- think too much ‘traffic’/WBCs on road so WBC and RBCs can’t get to destination

FUO, Bone marrow infiltration (anemia, thrombop, neutrop), organ infiltration of lymph nodes, bone, spleen, testes, NOT ovaries

Question 2

Chronic Lymphocytic Leukemia (CLL)

Answer 2

• slow onset - may be found incidentally (20-25% are asymptomatic)
• (Generalized) lymphadenopathy - MC presenting finding (80% of patients at dx)
• recurrent infections (pneumonia, HSV, HZV) – all viral
• hepatosplenomegaly (HSM) - upper abdominal discomfort/fullness and early satiety (50% of patients at dx)
• s/s of anemia/thrombocytopenia - often found later in course of disease

Question 3

Acute Myelogenous Leukemia (AML)

Answer 3

Bone marrow failure, organ infiltration (hepatosplenomegaly, leukostasis, CNS, Splenomegaly)

Anemia, Neutropenia, Thrombocytopenia

Question 4

Chronic Myeloid Leukemia (CML)

Answer 4

fatigue and weight loss¹ - often first symptom noted by patients
low-grade fevers, night sweats
abdominal fullness/discomfort, early satiety (HSM)
bone tenderness (sternum/anterior tibia)
results from bone marrow overexpansion
pruritus, diarrhea, flushing, gastrointestinal ulcers seen with elevated basophils due to overproduction of histamine
Accelerated disease
fevers of unknown origin, bone pain, marked splenomegaly
signs of acute leukemia related to anemia, neutropenia, thrombocytopenia
Physical Exam
splenomegaly - most common PE finding on exam
other findings: hepatomegaly, lymphadenopathy

philly w/ stages, 55 m

Question 5

Multiple Myeloma

Answer 5

Skeletal system - MC in the axial skeleton

• bone pain - MC presenting symptom in the back, hips, ribs
• spinal cord compression
• back pain, weakness, numbness, or dysesthesias in the extremities
• pathologic fracture
• skeletal destruction leads to hypercalcemia

Bone marrow
anemia, neutropenia, thrombocytopenia

Renal
impaired function/failure, proteinuria, oliguria

Neuro
radiculopathy or neuro deficits from spinal nerve
compression
peripheral nerve compression - MC median nerve (Carpal Tunnel Syndrome)

Plasmacytomas
bleeding, obstruction
aerodigestive tract (MC), orbital, ear canal,
cutaneous, gastric, rectal, prostatic, and retroperitoneal