Malignancies Flashcards
Leukemia
neoplastic disorder of the blood and bone marrow
what are neoplastic cells derived from?
myeloid or lymphoid cell lines
lymphoma
solid tumor of the RES, mostly lymph nodes
-also derived from lymphoid cell lines
clinical manifestations of leukemia
nonspecific but primarily include:
- fatigue
- musculoskeletal pain
- headache
exam findings of leukemia
fever hepatosplenomegaly lymphadenopathy bleeding infection pallor
lab findings of leukemia
- usually elevated WBC’s but range can be wide
- decreased RBCs and platelets
- anemia, thrombocytopenia
how to definitively diagnose leukemia
bone marrow biopsy
Acute Myeloid Leukemia (AML)
arises from myeloid stem cell line -Most common in adults >> Predisposing factors: - male gender - smoking - genetic (Down syndrome, Trisomy 8) -essential thrombocytosis -chemicals, radiation exposure, chemotherapeutic drugs
peripheral smear findings of AML
-blast cells (95% have myeloblasts)
-Auer rods in the cytoplasm of myeloblasts
(white cell inclusion body)
prognosis of AML
varies
-the older the patient, the worse the prognosis
Chronic Myelogenous Leukemia (CML)
Associated with the Philadelphia chromosome -> transposition gene responsible for tyrosine kinase signaling protein always on
what causes CML?
no clear cut cause except high dose irradiation
-no predisposing factors
tyrosine kinase signaling protein
responsible for replication & reproduction of myeloid cell
lab findings of CML
WBC > 100k *
- Thrombocytosis (>600k) often seen
- anemia
- increased basophils (Basophilia- rare) and generalized granulocytosis with immature forms
- not always WBC that is elevated in leukemia
what phase are patients in 85% of the time in the clinical course of CML?
chronic phase
- pts are asymptomatic
- at time of diagnosis - CBC is abnormal
sx of CML
acute gouty arthritis
- gout= crystalline arthritis sx
- uric acid = byproduct of DNA breakdown
what phase should patient with CML be restarted on chemo to prevent blast crisis?
accelerated phase
-peripheral smear shows 10-20% blasts
peripheral blood smear findings of CML
blasts
- basophilia
- granulocytosis w/ neutrophils & immature granulocytes
- blast crisis of ^^^
Acute Lymphocytic Leukemia (ALL)
most common leukemia in children with most favorable prognosis
- survival rate > 85%
- most children affected ( ~2-5 y/o) commonly w/ Down syndrome
- adults with ALL have Philadelphia chromosome
signs & sx of ALL
- musculoskeletal pain
- headache
- lymphadenopathy- nontender, solid & immobile
- testicular swelling
- mediastinal mass (thymus)
lab findings of ALL
CBC reveals
- anemia
- thrombocytopenia - 50% have bleeding
- normal or low WBC, but 20% have WBC > 50k
peripheral blood smear findings in ALL
lymphoblasts
- big nucleoli
- little cytoplasm (light blue)
CNS preventative therapy
- chemo is administered directly into CNS because it cannot pass BBB
- radiation tx
what type of vaccines should be avoided for patients with ALL?
live viruses
- varicella
- zoster
- MMR
- nasal influenza
