Blood/Acute & Chronic Leukemias
- 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.
- 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.
- List the signs and symptoms of acute leukemia:
- Leukemic cells infiltrate --> Organomegaly Dysfunction
- Lymph nodes --> Adenopathy
- Liver/Spleen --> Hepatosplenomegaly
- 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
- 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