Blood/Acute & Chronic Leukemias

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Objectives

General Objectives

  • Given the clinical presentation of a patient with an elevated WBC, the student will be able to:
    • List the diagnostic possibilities.
    • Discuss the diagnostic tests and results to confirm the suspected diagnosis.
    • List the possible treatment options and common complications that might arise from these therapies.
    • Discuss the expected prognosis of the patient.

Specific Objectives

  • Describe the major clinical laboratory features of acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeleogenous leukemia (CML) and chronic lymphocytic leukemia (CLL).
  • Differentiate between benign and malignant causes of leukocytosis.
  • List the possible treatment options, when available for these diseases and describe the risk/benefits expected with these treatments.
  • Describe the management of the common complications which might arise during the course of these disorders including bone marrow suppression, local effects of enlarged lymph nodes, pain and hyperviscosity.

Exam

  • List the signs and symptoms of acute leukemia:
    • Leukemic cells infiltrate --> Organomegaly Dysfunction
    • Lymph nodes --> Adenopathy
    • Liver/Spleen --> Hepatosplenomegaly
    • Skin/Gums
    • CNS --> Confusion/Decrease level of consciousness
    • Bone (rapid marrow expansion) --> PAIN
    • Marrow failure due to replacement of normal precursors by leukemic blasts
      • RBC --> Anemia --> Fatigue etc.
      • WBC --> Infections (Leukemic WBCs not functional)
      • Platelets --> Hemorrhage
    • Hyperviscosity - seen in acute leukemias with extremely high WBC (>100)
    • Leukostasis - Confusion --> Coma; Respiratory Distress
    • Hypermetabolic Symptoms
      • Fever (must always rule out infection first)
      • Weight loss
      • Hyperuricemia
    • Disseminated Intravascular Coagulation (DIC)
      • only associated with M3 - promyelocytic leukemia


  • Auer rods are found in myeloid cells (AML; CML)
  • Philadelphia chromosome is present in 85-90% of cases of CML

Notes