Malignancies

Question 1

Acute Luekemias

Answer 1

Reason: White blood cell cancer
Symptoms: Cytopenia ( Anemia, bleeding, Infection), Leukostasis (blast blocking blood flow: cause respiratory and heart problems), DIC and tumor lysis
Finidngs: 20% blast in blood, low WBC bc it lowers everything
labs: blood can have tumor lysis, Coag can show DIC

Question 2

Signs of Tumor Lysis

Answer 2

increase: potassium, uric acid, phosphorus, LDH
Decrease: Calcium

Question 3

Signs of DIC

Answer 3

Increase: PT, aPTT, Thrombin time, D dimers
Decrease: fibirogen

Question 4

Acute myloid leukemia

AML

Answer 4

Origin: Myloids
more common in older age

Question 5

Acute Lymphoid leukemia

ALL

Answer 5

Origin: Lymphoids
Common in kids
t(9:22) Ph+ philadelphia chromosome B cell
gets into the CNS so need drugs that get into to treat

Question 6

ALL and AML treatments

leukemia

Answer 6

maybe curable, based on age, Cytogenetics, high risk of HSC transplant

Question 7

Acute leukemia Intial management

Answer 7

1. infection
2. bleeding
3. Leukostasis AML»ALL
4. tumor lysis ALL»AML
5. DIC high risk with APL(AML subtype)

Question 8

How to treat tumor Lysis

Answer 8

ALL>AML>agressive lymphomas
Prevention: allopurinol (bc of the purine) in all leukmias and aggres lymphomas and hydration
Treatment: Hydration and rasburicase (urate oxidase)

Question 9

AML treatment base on performace

Answer 9

Good 50-60, Bad < 10
begin inudction:
good 7 + 3 regiment (Targeted therapy C A)
Bad Hypomethylating agents, Venetoclax

Question 10

Acute Promyelocytic Leukemia

Answer 10

HIGHEST RISK OF DIC
Granules can change into Rods ( tell tail sign that its APL)
Character: T(15;17) PML-RARalpha
TREATMENT: ATRA and Arsenic trioxide no chemotherapy
best early detection