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Hematology > Leukemias > Flashcards

Leukemias Flashcards

1
Q

Leukemia

A 
Cancer of the WBC's
Acute or chronic cell growth
Affects ability to produce normal cells
BM makes large amounts of immature cells
"crowd out" anemia, bleeding, infxn
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2
Q

Which blood-forming tissues does leukemia affect?

A

Bone Marrow
Lymph
Spleen

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3
Q

Myelogenous Leukemia

A

Characterized by proliferation of myeloid tissue (as of bone marrow and spleen)
Abnormal increase in the number of granulocytes, myelocytes and myeloblasts in circulating blood

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4
Q

Lymphocytic leukemias

A

Characterized by immature lymphocytes and their progenitors that originate in the BM, but infiltrate the spleen, lymph, CNS and other tissues.

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5
Q

AML

A

Primarily affects older people
Acute Myeloid Leukemia
Suppresses normal blood cell production

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6
Q

ALM risk factors

A 
Age (over 60)
Benzene exposure
Radiation
Tobacco (20% linkage)
Genetic disorders (Down syndrome)
Past chemo/meds/cancers
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7
Q

AML stats

A

12,000 new cases each year
50% mortality
65 yo 5 yr survival = 4%
20 - 30% experience remission and cure

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8
Q

AML Symptoms

A

Fatigue, SOB, Fever, Weight loss
Easy bruising, bleeding, recurrent infxns
Symptoms usually present for 3 or more months before dx is made.

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9
Q

AML signs

A 
FUO > 3 wks
Multiple bruises
GI, gingival bleed
Splenomegaly
Sternal tenderness
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10
Q

AML lab findings

A

Anemia (normochromic, normocytic)
Leukocytosis (around 150,000)
Thrombocytopenia <100,000

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11
Q

AML morphology

A

> 20% myeloblasts in blood/marrow
Auer rods (cytoplasmic granules)
Hypercellular bone marrow

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12
Q

AML tx

A

Chemotherapy (induction, intensification, maintainence)
Bone marrow transplant
Transfusions (for platelets <8)
Empirical Abx for fever
Allopurinol for increased uric acid levels

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13
Q

ALL

A

Acute Lymphoid Leukemia
Clonal proliferation and accumulation of blast cells in blood, marrow and other organs.
Originates in B or T cell progenitor
20% of acute leukemias

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14
Q

ALL stats

A

3,000 new cases per year in children
Mostly affects children (peak 4 yrs)
May be B, T cell or null (neither)

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15
Q

ALL Symptoms

A

Fever, fatigue, SOB, weight loss/fatigue
Bleeding, bruising, petechiae
Bone Pain

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16
Q

ALL signs

A 
Fever
Splenomegaly, hepatomegaly
Lymphadenopathy
Multiple bruises, petichiae
Unexplained infxns
CN palsies, HA, N/V, papilledema
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17
Q

ALL lab findings

A

Anemia (normochromic, normocytic)
WBC < 5000, or > 25,000
Thrombocytopenia
Blast cells

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18
Q

in ALL, is B or T cell lineage more common?

A

B cell lineage (85%)

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19
Q

ALL morphology

A

L1: Small round blasts, clumped chromatin
L2: Pleomorphic larger blasts, clefted nuclei, fine chromatin
L3: Large blasts, nucleoli, vacuolated cytoplasm

20
Q

Chromosome philadelphia

A

If positive, indicated VERY high-risk ALL

21
Q

High-risk ALL

A

Over 35 yrs old
>30 G/L in B-ALL
>100 G/L in T-ALL
NO remission after 4 weeks of induction therapy

22
Q

ALL Tx

A 
Antineoplastic treatment
CNS preventative tx
supportive care
Tx of complications
Chemotherapy (methotrexate)
Stem cell transplant
23
Q

ALL prognosis

A

Children: complete remission (CR) 95 - 99%
Children: leukemia-free survival (LFS) 80%
Adults: CR 80 - 85%
Adults LFS: 30 - 40%

24
Q

CML

A

Chronic Myeloid Leukemia
Proliferative disorder of hematopoetic stem cells
Has Ph (Philadelphia) chromosome and Bcr-Abl tyrosine kinase

25
Q

Bcr-Abl Tyrosine Kinase

A

A single molecular abnormality that causes transformation of a hematopoetic progenitor into a malignant clone.

26
Q

3 phases of CML

A

Chronic phase
Accelerated phase
Blast crisis

27
Q

CML stats

A

1-2 cases per 100,000 ppl
More common in women
Median age is 50 yrs

28
Q

Philadelphia chromosome present in _____ of cases.

A

95%

29
Q

CML S/S

A 
40% asymptomatic
Splenomegaly (increased abd girth)
Anemic features
Abnormal platelet fxn
Gout, visual disturbances
Chronic infxn - fever
30
Q

CML lab findings

A

Anemia (normochromic, normocytic)
Leukocytosis (20,000)
Basophilia
Thrombocytopenia

31
Q

CML morphology

A 
Hypercellular (reduced fat spaces)
Myeloid erythroid ratio 10:1 to 30:1.
Myelocyte predominant cell, blasts <10%
Megakaryocytes increased and dysplastic
Increased reticulin fibrosis
32
Q

CML chronic phase

A

85%
lasts 3-5 years
Treatment w/ alpha interferon

33
Q

CML accelerated phase

A 
difficult to control
lasts 6 - 9 months
Symptoms related to hypermetabolism
Blasts > 15% in blood
Thrombocytopenia
Basophils >20%
34
Q

CML blastic phase

A

Resembles acute leukemia
Diagnosis requires >30% blasts in marrow
Survival is around 3 months

35
Q

CML tx

A 
Prolong chronic phase
Alpha interferon, chemo
Hydration
Eradicate malignant clone
Allogenic transplantation
36
Q

CML prognosis

A

Median survival: 3.5 yrs
Interferon and Chemo: 6 yrs
Transplant: 5+ yrs

37
Q

CLL

A

Chronic lymphoid leukemia
4 - 7 cases per 100,000 ppl
30% of all leukemia cases
Most common lymphoid lukemia

38
Q

CLL stats

A

Median age is 70 years
only 10% of pts are <50 yrs old
More males than females
80% due to B lymphocytes

39
Q

CLL Symptoms

A

25% are asymptomatic at time of dx
fever, night sweats, fatigue, SOB, pallor
Easy bruising, bleeding, weight loss, infxns

40
Q

CLL signs

A 
Fever
spleno/hepatomegaly
Lymphadenopathy
Multiple bruises
Easy bleeding
Leukemia cutis
41
Q

CLL lab findings

A

Lymphocytes > 20,000 microL, which is usually 75 - 98% lymphocytes
HCT and platelets are normal
Smudge cells, soccer balls **
B cell specific differentiation antigens

42
Q

CLL Rai classifications, survival rates

A

0: Lymphocytosis >5 G/L (>10 yrs)
I: Lymphocytosis + Lymphadenopathy (>8 yrs)
II: “ + splenomegaly (6 yrs)
III: “ + anemia < 2 yrs)

43
Q

CLL Tx

A 
Alkylating agents
Nucleoside analogs
Monoclonal antibodies
Bone marrow transplant
Tx of symptoms (abx, steroids, blood)
44
Q

Hairy Cell Leukemia

A

2% of all adult leukemias
Usually in males >40
Chronic disease of B cell proliferation

45
Q

Hairy Cell S/S

A 
Splenomegaly
Pancytopenia
Infxn
Vasculitis
Decreased WBC and platelets
Hairy Cells
46
Q

Hairy Cell Tx

A

Chemo
Alpha-interferon
Good prognosis

Hematology (14 decks)

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