Hematology-Leukemias
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- What is the peak age for acute lymphoblastic leukemia
- peak age 3-4yr
- What is the most common neoplasm in children?
- Actue lymphoblastic leukemia
- What are the signs and symptoms of acute lymphoblastic leukemia
-
sx: fever, fatigue
si: anemia, pallor, petechiae, infections - What labs are used to diagnose acute lymphoblastic leukemia
- Leukocytosis, blastsin pheripheral blood, decreased RBC count, decreased platelets, PAS+, CALLA+, TdT+, marrow bx shows increased blasts
- What cancer are increased blasts in bone marrow characteristic of?
- acute lymphoblastic leukemia
- What cell markers are diagnostic of actue lymphoblastic leukemia?
- PAS+, CALLA+, TdT+
- Describe the course of therapy in acute lymphoblastic leukemia
- induction, condsolidation and maintenance (intrathecal chemotherapy during consolidation)
- What are the side effects of therapy given for acute leukoblastic leukemia? (3)
- new cancers, incrased rate of sterility, growth defects
- What is the diagnosis given these markers: PAS+, CALLA+, TdT+?
- acute lymphoblastic leukemia
- What is the most common leukemia in adults?
- acute myelogenous leukemia
- Who gets acute myelogenous leukemia
- adults
- How is actue myelogenous leukemia classified?
- FAB system: M0-M7
- What are the signs and symptoms of acute myelogenous leukemia? (7)
- fever, fatigue, pallor, petechiae, infections, splenomegaly, lymphadenopathy
- What leukemia is myeloperoxidase+, sudan black+, auer rods, throbocytopenia, peripheral blood & marrow bx shows myeloblasts
- acute myelogenous leukemia
- What are 5 characteristic lab findings of actue myelogenous leukemia?
-
myeloperoxidase+
sudan black+
auer rods
throbocytopenia
peripheral blood & marrow bx shows myeloblasts - What is the course of treatment for acute myelogenous leukemia?
- induction and consolidation only
- What is the difference in treatment between actue lymoblastic leukemia and acute myelogenous leukemia?
- actue lyphoblastic leukemia treatment has a maintenance phase
- M1: myeloblastic shows what 3 histologic features?
-
+ auer rods
+ sudan black
+ myeloperoxidase (MPO) - M2: myeloblastic with differentiation shows what 3 histologic features?
-
++ auer rods
+ sudan black
+++ myeloperoxidase (MPO) - What acute myelogenous leukemia subtype has prominent splenomegaly and + chloromas (green tumors made up of blasts)?
- M2: myeloblastic with differention
- M3: promyelocytic shows what 3 histologic features?
-
+++ auer rods
increased granularity
+++ myeloperoxidase - What leukemia has t(15:17) and what does it affect?
- M3: Promyelocytic, affects retinoid acid receptor
- DIC is common in what leukemia
- M3: promyelocytic (acute myelogenous leukemia)
- What drug is used to treat t(15:17)
- ATRA - all trans retinoic acid is used to induce blast differentiation
- What subtype of acute myelogenous leukemia involves eosinophils?
- M4: Myelomonocytic
- What subtype of actue myelogenous leukemia involves CNS and gingiva
- M5: monocytic
- What condition often precedes M6: Erythroblastic subtype of acute myelogenous leukemia?
- myelodysplasia
- What is the most common age for chronic myelogenous leukemia (CML)?
- 50's but can present at any age
- What are 7 symptoms of CML?
-
fatigue
anorexia
abdominal discofort
early satiety
diaphoresis
arthritis
bone tenderness - What characterizes the peripheral blood smear
- leukostatis (WBC >=10^5)
- What are 7 clinical consequences of leukostatis (WBC >=10^5)?
-
dyspnea
dizziness
slurred speech
diplopia
confusion
retinal hemorrhage
pepilledema - What are 4 lab findings of CML?
-
neutrophilia
thrombocytosis
Philadelphia chromosome
peripheral blood shows cells of all maturational states - What treatment used in CML? What is it's target?
- Gleevac, philadelphia chromosome product bcr-abl
- What is blast crisis in CML and what is it's outcome?
- actue phase CML, leads to death in 3-4 mo, only BMT can prevent
- What is pathopnomonic of CML
- Philadelphia chromosome
- What does the Philadelphia chromosome cause? Wha is the translocation?
-
constitutive tyrosine kinase activity, t(9:22) ->bcr-abl
promotes the cell cycle - What is the level of leukocyte alkaline phosphatase in CML vs leukemoid reaction
-
CML: low
Leukemoid reaction: high - What is the age distribution of chronic lymphocytic leukemia (CLL)?
- increases with age
- What cell is proliferating in CLL?
- 95% are memory B-cel types (a flrom of blood borne lymphoma) expressing CD5 protein as a surface marker
- What are 3 signs of CLL
-
organomegaly
+/- anemia
later stages see throbocytopenia due to autoimmunity - What are 3 lab findings of CLL
-
normal morphology lymphocytes of blood and marrow
monolonal antibodies (check to determine monoclonality)
autoimmune hemolysis (Coomb's +, increased indirect bilirubin, decreased haproglobin, spherocytosis) - What are 4 causes of anemia in CLL
-
autoimmunity
splenomegaly
bone marrow infiltration
chemotherapy - What causes death in CLL
- infection
- What is the translocation in CLL and what is the result?
- t(11:14), bcl1 next to heavy chain promoter
- What is the general presentation of T cell leukemias
- erythematous rashes
- What type of leukemia is hairy cell leukemia
- B cell type
- What are 3 findings that characterize hair cell leukemia
-
pancytopenia
erythema nodosum
hair cell morphology - What is the treatment for hair cell leukemia
-
INF-alpha
splenectomy - What are the most common ages for CML, CLL, AML, ALL
-
ALL: up to age 15
AML: 15-59
CML: 40-59
CLL: 60+ - What is HTLV and what dows it cause?
-
HTLV is human T cell leukemia virus
Causes leukemia and tropical spastic paraparesis - Where is HTLV most common
- Japan and Caribbean
- How is HTLV transmitted
- Like HIV: placenta, body fluids & sex