16 Acute Leukemia

  • hallmark: increased WBC count in peripheral blood
  • lymphoma: increased WBC in lymph nodes

Classification

  • malignancy from myeloblasts: AML
  • progenitor cells become malignant and overproduces: myeloproliferative
  • red cell: polycythemia
  • granulocytes: CML, leukemia since WBC
  • platelets: thrombocytosis

  • CLL: more mature lymphocytes

ALL

  • nonspecific symptoms, just don't feel well and feel sick
  • bone pain: marrow expanding, filling up with blasts
  • organs enlarge: blasts leak out of marrow and fill up organs

  • large cells with large nucleus

  • understand development to understand special tests. Know markers
  • CD10, 19, 20, 21: B cell
  • TdT: developing cell

  • T lower number

B ALL

  • usually pre B
  • CD 10: CALLA, found on blasts in ALL

  • sanctuary sites: special treatment

  • ALL uncommon in adults, and worse outcome
  • 12:21, common in children, thus good prognosis

  • trisomy 21
  • translocation less frequent in down syndrome

T ALL

  • older kids
  • thymus: where T develop
  • thymus usually involved and enlarged: widened mediastinal mass
  • tracheal obstruction: difficulty breathing

AML

  • gums: classic presentation of thrombocytopenia

  • see few RBC, platelets
  • blasts are myeloblasts: no lymphoblast surface antigens
  • MPO stain positive

  • if MPO from auer rods spill into blood, cause DIC

APML

  • high frequency of DIC
  • pts often thrombocytopenic from leukemia. If DIC occurs, can get very sick
  • suspect APML if blasts in periphery and DIC on presentation

MDS

  • minor versions of AML
  • no high number of blasts, not leukemia
  • symptoms of pancytopenia
  • blasts less than 20% in bone marrow
  • sideroblasts often seen in bone marrow biopsy

  • cancer treated with chemo