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