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Which type of leukemia primarily affects children and young adults?
Which type of leukemia primarily affects children and young adults?
Acute Myeloid Leukemia (AML) is commonly diagnosed in individuals younger than 45 years of age.
Acute Myeloid Leukemia (AML) is commonly diagnosed in individuals younger than 45 years of age.
False
What is the typical first-line treatment for Acute Lymphoblastic Leukemia (ALL)?
What is the typical first-line treatment for Acute Lymphoblastic Leukemia (ALL)?
Chemotherapy
In Chronic Myeloid Leukemia (CML), the early course is usually _____ and progresses to an aggressive phase in 3-4 years.
In Chronic Myeloid Leukemia (CML), the early course is usually _____ and progresses to an aggressive phase in 3-4 years.
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Which leukemia type involves the abnormal growth of marrow cells that form RBCs, WBCs (other than lymphocytes), and platelets?
Which leukemia type involves the abnormal growth of marrow cells that form RBCs, WBCs (other than lymphocytes), and platelets?
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Match the type of leukemia with its primary affected demographic:
Match the type of leukemia with its primary affected demographic:
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Fatigue is a common symptom of all types of leukemia mentioned.
Fatigue is a common symptom of all types of leukemia mentioned.
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What common treatment is used in both Chronic Lymphocytic Leukemia (CLL) and Acute Myeloid Leukemia (AML)?
What common treatment is used in both Chronic Lymphocytic Leukemia (CLL) and Acute Myeloid Leukemia (AML)?
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What is the 5-year survival rate for individuals diagnosed with CLL?
What is the 5-year survival rate for individuals diagnosed with CLL?
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Women are more frequently affected by leukemia than men.
Women are more frequently affected by leukemia than men.
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Name two genetic disorders that increase the incidence of ALL in children.
Name two genetic disorders that increase the incidence of ALL in children.
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Patients with a history of __________ may have an increased risk of developing leukemia.
Patients with a history of __________ may have an increased risk of developing leukemia.
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Which of the following is a known cause of certain leukemias and lymphomas?
Which of the following is a known cause of certain leukemias and lymphomas?
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Smoking is considered a risk factor for both AML and ALL.
Smoking is considered a risk factor for both AML and ALL.
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What is one environmental risk factor associated with an increased risk of CML?
What is one environmental risk factor associated with an increased risk of CML?
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Match the following leukemia risk factors with their associated types:
Match the following leukemia risk factors with their associated types:
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What is a common symptom of acute lymphocytic leukemia (ALL)?
What is a common symptom of acute lymphocytic leukemia (ALL)?
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Chronic myeloid leukemia (CML) is most commonly diagnosed in children.
Chronic myeloid leukemia (CML) is most commonly diagnosed in children.
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What phase of CML is characterized by blast cells proliferating and infiltrating tissues?
What phase of CML is characterized by blast cells proliferating and infiltrating tissues?
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The Philadelphia chromosome is associated with __________.
The Philadelphia chromosome is associated with __________.
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Match the type of leukemia with its primary characteristic:
Match the type of leukemia with its primary characteristic:
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What genetic alteration is commonly implicated in both CML and ALL?
What genetic alteration is commonly implicated in both CML and ALL?
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Thrombocytopenia refers to a decreased number of white blood cells.
Thrombocytopenia refers to a decreased number of white blood cells.
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What are common manifestations of thrombocytopenia?
What are common manifestations of thrombocytopenia?
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Acute myeloid leukemia often leads to __________ due to decreased neutrophils.
Acute myeloid leukemia often leads to __________ due to decreased neutrophils.
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Match the leukemia type with its typical patient demographics:
Match the leukemia type with its typical patient demographics:
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In chronic lymphocytic leukemia (CLL), which type of lymphocyte is usually abnormally increased?
In chronic lymphocytic leukemia (CLL), which type of lymphocyte is usually abnormally increased?
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Anemia is an early symptom of acute myeloid leukemia.
Anemia is an early symptom of acute myeloid leukemia.
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What is the average age of diagnosis for chronic lymphocytic leukemia (CLL)?
What is the average age of diagnosis for chronic lymphocytic leukemia (CLL)?
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Increased lymphocytes in a complete blood count (CBC) indicates __________.
Increased lymphocytes in a complete blood count (CBC) indicates __________.
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What is a common treatment that produces remission in adults with ALL?
What is a common treatment that produces remission in adults with ALL?
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Which of the following is a common manifestation of increased intracranial pressure due to meningeal infiltration in leukemia?
Which of the following is a common manifestation of increased intracranial pressure due to meningeal infiltration in leukemia?
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Anemia in leukemia patients results from the overproduction of white blood cells (WBCs) leading to a decrease in red blood cells (RBCs).
Anemia in leukemia patients results from the overproduction of white blood cells (WBCs) leading to a decrease in red blood cells (RBCs).
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What is a potential effect of renal infiltration by leukemic cells?
What is a potential effect of renal infiltration by leukemic cells?
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Leukemia can cause symptoms such as _____, which include frequent or recurrent infections.
Leukemia can cause symptoms such as _____, which include frequent or recurrent infections.
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Match the following clinical manifestations of leukemia with their descriptions:
Match the following clinical manifestations of leukemia with their descriptions:
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Which of the following clinical therapies is commonly employed to improve hydration in leukemia patients?
Which of the following clinical therapies is commonly employed to improve hydration in leukemia patients?
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Bleeding gums in leukemia patients are typically caused by an increased number of platelets.
Bleeding gums in leukemia patients are typically caused by an increased number of platelets.
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Name a symptom of leukemia that results from increased metabolism.
Name a symptom of leukemia that results from increased metabolism.
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What symptom commonly results from anemia in leukemia patients?
What symptom commonly results from anemia in leukemia patients?
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Which of the following symptoms is indicative of infection in leukemia patients?
Which of the following symptoms is indicative of infection in leukemia patients?
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What is a potential serious consequence of the release of uric acid due to the destruction of white blood cells?
What is a potential serious consequence of the release of uric acid due to the destruction of white blood cells?
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Which finding is associated with meningeal infiltration in leukemia?
Which finding is associated with meningeal infiltration in leukemia?
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How does leukemic cell infiltration of lymph nodes manifest clinically?
How does leukemic cell infiltration of lymph nodes manifest clinically?
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What clinical intervention is primarily used to manage anemia in leukemia patients?
What clinical intervention is primarily used to manage anemia in leukemia patients?
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Which symptom is a common manifestation of thrombocytopenia in leukemia patients?
Which symptom is a common manifestation of thrombocytopenia in leukemia patients?
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What is a common metabolic effect seen in patients with leukemia due to increased metabolism?
What is a common metabolic effect seen in patients with leukemia due to increased metabolism?
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Study Notes
Acute Myeloid Leukemia (AML)
- Uncontrolled proliferation of myeloblasts (precursors of granulocytes)
- Hyperplasia of bone marrow and spleen
- Uncommon in individuals younger than 45 years of age
- Accounts for 32% of newly diagnosed leukemia cases in adults
- Average age at diagnosis is 68 years
- 5-year survival rate is approximately 25%
- Manifests due to neutropenia and thrombocytopenia
- Weakness and fatigue are common complaints
- Recurrent severe infections due to decreased neutrophils (mucous membrane ulceration, pneumonia, septicemia, and abscesses)
- Manifestations of thrombocytopenia include ecchymoses, petechiae, purpura, epistaxis, hematuria, hematomas, and GI bleeding
- Anemia is a late manifestation, causing fatigue, headaches, pallor, and dyspnea on exertion
- Death usually results from infection or hemorrhage
- Bone marrow aspiration shows a proliferation of immature WBCs
- CBC shows thrombocytopenia and normocytic, normochromic anemia
Chronic Myeloid Leukemia (CML)
- Abnormal proliferation of all bone marrow elements
- Constitutes approximately 15% of adult leukemias
- Affects men more frequently than women
- Average age at diagnosis is approximately 65 years
- Very rarely seen in children
- Usually associated with the Philadelphia chromosome (balanced translocation of chromosome 22 to chromosome 9)
- Translocation creates a fusion gene, BCR-ABL, which is an oncogene capable of initiating a malignancy
- Very large doses of ionizing radiation may induce CML in some patients
- Early phase (chronic): often asymptomatic or with very mild, vague symptoms
- Often diagnosed during routine blood tests
- Accelerated phase: common symptoms include decreased appetite, weight loss, and fever
- Acute phase (blast crisis or blast phase): blast cells proliferate and spread beyond the bone marrow, infiltrating tissues and organs
- Manifestations of acute phase: splenomegaly, bone damage, and an extremely high or low platelet count
Acute Lymphocytic Leukemia (ALL)
- The most common type of leukemia in children and adolescents
- Incidence decreases after the mid-20s and then gradually increases after about age 50
- Genetic factors may play a role in its development, particularly the BCR-ABL fusion gene also implicated in CML
- Genetic alterations cause cellular proliferation of malignant, immature lymphocytes (lymphoblasts) that do not mature or function effectively to maintain immunity
- Leukemic cells accumulate in the bone marrow, lymph nodes, and spleen, as well as in circulating blood
- Usually rapid onset
- Early signs and symptoms include fever, bleeding, lymphadenopathy, and bone pain
- Lymphoblasts proliferating in bone marrow and peripheral tissues crowd the growth of normal cells
- Normal hematopoiesis is suppressed, leading to thrombocytopenia, leukopenia, and anemia
- Manifestations of infections, bleeding, and anemia develop
- Lymphadenopathy, liver enlargement, and bone pain (especially in children) resulting from rapid generation of marrow elements are also common
- Infiltration of the central nervous system causes vomiting, headaches, visual disturbances, and seizures
- CBC shows an elevated WBC count with increased lymphocytes on the differential
- Platelet counts and RBCs are decreased
- Bone marrow studies reveal a hypercellular marrow with the growth of lymphoblasts
- Combination chemotherapy produces complete remission in 80–90% of adults with ALL
- Relapse is common among adults, and the rate of cure for this population is closer to 40%
- 5-year survival rate among children with ALL is estimated to be approximately 90%
Chronic Lymphocytic Leukemia (CLL)
- Proliferation and accumulation of small, abnormal, mature lymphocytes in the bone marrow, peripheral blood, and body tissues
- Abnormal cells are usually B lymphocytes that are unable to produce adequate antibodies to maintain normal immune function
- Statistically the most common form of leukemia diagnosed in adults 20 years of age and older
- Rarely seen in children or adults under the age of 40 years
- Average age at diagnosis is 70 years
- Slow onset and often diagnosed during a physical examination and/or routine blood tests
- Symptoms usually include vague complaints of weakness or malaise and a temperature greater than 38°C (100.5°F) for 2 weeks without evidence of infection
- Clinical manifestations may include lymphadenopathy, splenomegaly, or hepatomegaly
- Bone marrow hyperplasia is present
- Erythrocyte and platelet counts are reduced
- Leukocyte counts may be either elevated or reduced, but abnormal cells are always present
- 5-year survival rate for individuals diagnosed with CLL is 85%
Risk Factors
- Men are affected more frequently than women
- Children with immunodeficiency states, such as ataxia-telangiectasia, congenital hypogammaglobulinemia, and Wiskott-Aldrich syndrome, have an increased risk of ALL
- Patients who have undergone treatment for cancer may also have an increased risk
- The human T-cell leukemia/lymphoma virus type 1 (HTLV-1), a retrovirus, is known to cause certain leukemias and lymphomas
- People with certain genetic disorders have a higher incidence of leukemia
- Children with chromosomal defects, such as Down syndrome, Klinefelter syndrome, Bloom syndrome, and Fanconi anemia, have an increased incidence of ALL
- Chromosomal abnormalities are present in many patients with ALL, but these mutations are generally believed to have transpired during the individual's lifetime, rather than being inherited
- Several chromosomal and genetic abnormalities are associated with AML; however, these abnormalities are rarely due to inherited DNA mutations
- Environmental risk factors have a role as well
- Risk factors for AML include smoking and exposure to chemicals, such as benzene (present in cigarette smoke and gasoline)
- Exposure to high-dose ionizing radiation (nuclear reactor or atomic blast) increases the risk for both AML and ALL
- There are very few known environmental or lifestyle-related causes of childhood or other leukemias; therefore, there is no sure way to prevent them from developing
- Exposure to high-dose radiation is the only proven modifiable risk factor for CML
- CLL may possibly be associated with certain chemical exposures (e.g., specific pesticides); however, more research is needed
- Diet, smoking, or infections do not appear to be linked to the development of CLL
Clinical Manifestations of Leukemia
- General Manifestations: Anemia, infection, and bleeding are the primary causes of general symptoms. This leads to fatigue, pallor, tachycardia, malaise, lethargy, and dyspnea on exertion.
- Infection: Immature white blood cells (WBCs) are ineffective at fighting infections, leading to fever, night sweats, oral ulcerations, and frequent or recurrent respiratory, urinary, integumentary, or other infections.
- Bleeding: Thrombocytopenia causes increased bleeding, resulting in bruising, petechiae, bleeding gums, and bleeding within specific organs and tissues.
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Leukemic Cell Infiltration:
- Meningeal infiltration: Increases intracranial pressure causing headache, altered level of consciousness, cranial nerve impairment, and nausea and vomiting.
- Lymph nodes, liver, spleen, and bone marrow infiltration: Causes pain and tissue swelling in the involved areas.
- Kidney infiltration: Affects renal function, causing decreased urine output and increased blood urea nitrogen and creatinine.
- Increased Metabolism: Causes weight loss, heat intolerance, dyspnea on exertion, and tachycardia.
- Increased Leukocyte Destruction: Releases substantial amounts of uric acid into circulation, which can obstruct renal tubules, causing renal insufficiency.
Therapies for Leukemia
-
Anemia:
- Improve hydration and nutritional status.
- Stimulate RBC production with medications (e.g., epoetin).
- Perform blood transfusions.
- Promote rest.
- Monitor vital signs and CBC.
-
Infection:
- Teach infection prevention strategies (e.g., hand hygiene, cough etiquette, crowd avoidance).
- Teach symptoms to report.
- Give antimicrobials as indicated to treat infections.
- Monitor vital signs and CBC.
-
Bleeding:
- Monitor coagulation studies.
- Provide patient teaching to reduce injury risk.
- Administer platelets and clotting factors.
- Monitor CBC to detect blood loss and determine if blood transfusion is needed.
Clinical Manifestations of Leukemia
-
General Manifestations: Result from anemia, infection, and bleeding.
- Anemia: Fatigue, pallor, tachycardia, malaise, lethargy, and dyspnea on exertion.
- Infection: Fever, night sweats, oral ulcerations, and frequent or recurrent respiratory, integumentary, urinary, or other infections.
- Bleeding: Bruising, petechiae, bleeding gums, and bleeding within specific organs and tissues.
-
Other Manifestations:
-
Leukemic cell infiltration:
- Meningeal infiltration: Increased intracranial pressure, such as headache, altered level of consciousness, cranial nerve impairment, and nausea and vomiting.
- Infiltration of lymph nodes, liver, spleen, and bone marrow: Pain and tissue swelling in the involved areas.
- Infiltration of the kidneys: Decreased urine output and increased blood urea nitrogen and creatinine.
- Increased metabolism: Weight loss, heat intolerance, dyspnea on exertion, and tachycardia.
- Increased leukocyte destruction: Release of substantial amounts of uric acid into the circulation, which can obstruct renal tubules and cause renal insufficiency.
-
Leukemic cell infiltration:
Clinical Manifestations of Anemia in Leukemia
- Caused by overproduction of WBCs in the bone marrow, leading to inadequate number of circulating RBCs.
Clinical Manifestations of Infection in Leukemia
- Caused by immature WBCs being ineffective in responding to pathogens.
Clinical Manifestations of Bleeding in Leukemia
- Caused by reduced coagulation factors, increased fibrinolytic activity, and accelerated intravascular coagulation.
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Description
This quiz covers key aspects of Acute Myeloid Leukemia (AML), including its characteristics, diagnosis, and common symptoms. It details the demographics of affected individuals, survival rates, and complications, emphasizing the importance of recognizing signs such as neutropenia and thrombocytopenia. Test your understanding of this critical hematological condition.
