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