RPA haem Flashcards
AML vs CML on blood film
AML - large blasts, similar morphology CML - leukocytes in various stages of development; smaller sized
AML vs CML and bone marrow failure
AML is always assoc w BM failure where as CML is rarely assoc w BM failure Hence, AML presents w signs and symptoms of failures of the various lineages
Sweet’s syndrome
pruritic rash of the skin due to neutrophilic infiltration in skin could be caused by AML but also other immunological or iatrogenic causes
what type of AML is assoc w severe DIC
APML
4 tests at diagnosis for AML
morphology immunophenotype - good for distinguishing bw ALL and M chromosome analysis mutation analysis
proportion of AML w positive chromosome analysis
45%
AML vs ALL blood film
AML - fine granules/Auer rods - Auer rods are fine granules stuck together in a linear fashion - much cytoplasm ALL - no granules - slightly smaller blasts - scant cytoplasm
immunophenotyping characteristics of myeloid vs lymphoid
myeloid is generally higher number (aside from CD 13) myeloid CD 13, 33, 34, 117 lymphoid CD 3, 10, 19, blahblah
turnaround for FISH vs chromosome
6-8hr (FISH) vs a few days (chromosome)
AML w inferior prognosis
FLT3
APML blood film
promyelocytes very heavy granulation occasionally vaccuolated sometimes loaded with auer roads in bundles due to heavy granules
APML and DIC pathogenesis
85% of APML willdevelop DIC
APML membrane has a transmembrane glycoprotein that initiates coagulation causing DIC
release of tissue factor -> excessive release of thrombin plasminogen -> plasmin -> fibrinolysis -> clot formation can present w pancytopenia without blasts, with bruising +++
APML and DIC pathogenesis
85% of APML willdevelop DIC APML membrane has a transmembrane glycoprotein that initiates coagulation causing DIC release of tissue factor -> excessive release of thrombin plasminogen -> plasmin -> fibrinolysis -> clot formation can present w pancytopenia without blasts, with bruising +++
is d-dimer due to fibrin degredation or formation
formation as d-dimer is produced by plasmin lysis of cross-linked fibrin in thrombus
the most reliable index of DIC
D-dimer
APML cytogenetic abnormality
t(15,17)
how to detect APML cytogenetic abnormality
on FISH
what fusion gene is found in APML
PML/RAR alpha fusion protein
what does ATRA (all trans retinoic acid) target in APML
PML/RAR alpha fusion protein promotes differentiation
treatment of APML
ATRA + ATO (arsenic trioxide) +/- chemotherapy
ATRA syndrome
cell differentiation induced by ATRA leads to rising WCC and cytokine release –> leaky capillaries –> resp distress –> fluid overload Mx: steroids + chemotherapy
what chemotherapy agent is contained in all AML regimens
cytarabine (except APML where sometimes chemotherapy is not required)
what causes acute obstructive nephropathy in TLS
precipitation of UA, xanthine and phosphate in renal tubules
CML peripheral film
similar to a bone marrow can see full range of cell development stages