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
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
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