24 Questions
What is the result of leukemic blasts building up in the bone marrow?
Suppression of the development of healthy blood cells
What is the term for a low number of healthy red blood cells, white blood cells, and platelets?
Pancytopenia
What is the term for small, red spots on the skin due to bleeding under the skin?
Petechiae
What is the term for a low number of platelets in the blood?
Thrombocytopenia
What is the result of a DNA mutation in myeloid stem cells?
Immature blast cells are stuck in the earliest stages of cell development
What is the term for a low number of white blood cells in the blood?
Neutropenia
What is the term for cancer that arises from prior myeloproliferative disorder or myelodysplastic syndrome?
Secondary AML
What is the term for a rod-like structure found in leukemic blasts in AML?
Auer rod
What can the accumulation of leukemic cells in peripheral blood and lymphoid organs lead to?
Anemia, thrombocytopenia, leukopenia, and organomegaly
What is a common symptom experienced by adults with leukemia?
Shortness of breath
What is the purpose of a comprehensive metabolic panel in the diagnosis of leukemia?
To evaluate electrolyte and acid-base status
What is the role of immunophenotyping in the diagnosis of leukemia?
To detect certain proteins on a cell's surface
What is the primary goal of therapy in the management of leukemia?
To initiate treatment based on the leukemia subtype and patient factors
What is the purpose of a hematopoietic stem cell transplant in the treatment of leukemia?
To administer healthy hematopoietic stem cells to patients with dysfunctional or depleted bone marrow
Which of the following is a characteristic of acute leukemias?
They require frequent monitoring of vitals and assessment for opportunistic infections
What is the role of fluorescence in situ hybridization (FISH) in the diagnosis of leukemia?
To detect certain abnormal changes in chromosomes and genes
Where do leukemias start in the body?
Blood-forming tissue, the bone marrow
What is the main characteristic of acute leukemias in terms of cell maturity?
Cells are generally immature, poorly differentiated, and abnormal
What is the result of malignant transformation of pluripotent hematopoietic stem cells in the body?
Leukemia
What is the effect of blasts on normal blood cells in acute leukemias?
They replace and interfere with their development and function
What is the main characteristic of chronic leukemias in terms of cell maturity?
Cells are partially mature and do not function effectively
What is the role of blood stem cells in the body?
They are constantly dividing and changing into different types of blood cells
What is the result of clonal expansion and proliferation of blasts in acute leukemias?
Replacement and interference with the development and function of normal blood cells
What is the term for the abnormal leukocytes that can either be lymphoblasts or myeloblasts in acute leukemias?
Blast cells
Study Notes
Leukemia
- Leukemias are cancers of blood cells that start in the blood-forming tissue, the bone marrow.
- They can be classified as acute or chronic based on the rapidity of proliferation and myeloid or lymphoid based on the cell of origin.
Main Subtypes
- Acute Myeloid Leukemia (AML)
- Acute Lymphoblastic Leukemia (ALL)
- Chronic Myeloid Leukemia (CML)
- Chronic Lymphocytic Leukemia (CLL)
Acute Vs. Chronic Leukemias
- Acute leukemias: rapid onset, immature blast cells, and poor prognosis.
- Chronic leukemias: slow onset, partially mature cells, and relatively better prognosis.
Etiology
- Ionizing radiation
- Benzene exposure (particularly AML)
- Previous exposure to chemotherapy
- A history of any hematologic malignancy
- Viral infections (e.g., human T-cell leukemia virus, Epstein-Barr virus) (particularly ALL)
- Several genetic syndromes (e.g., Down syndrome, Fanconi anemia, Bloom syndrome)
Pathophysiology
- Leukemia occurs due to the malignant transformation of pluripotent hematopoietic stem cells.
- In acute leukemias, immature blast cells undergo clonal expansion and proliferation, leading to replacement and interference with normal blood cells.
- In chronic leukemias, partially mature cells do not function effectively and divide too quickly.
Signs and Symptoms
- Anemia: fatigue, weakness, shortness of breath, dizziness or faintness
- Neutropenia: frequent infections, fever
- Thrombocytopenia: bruising easily, petechiae, prolonged bleeding from minor cuts
- General Symptoms: loss of appetite, unexplained weight loss, discomfort in bones or joints, fullness or swelling in the abdomen
Histology
- Auer rods (AML)
Classification - AML
- Based on the etiology of the AML, it can be categorized into:
- De novo AML
- Secondary AML (s-AML), which evolves from prior MPD or MDS
Clinical Presentation
- Increased risk of infection and fever
- Lethargy
- Anemia-related symptoms
- Symptoms related to thrombocytopenia
Diagnosis
- CBC
- Comprehensive metabolic panel
- Coagulation panel
- Peripheral blood smear evaluation
- Bone marrow biopsy and aspiration
- Cell Examination:
- Immunophenotyping (Flow Cytometry)
- Cytogenetic Analysis (Karyotyping)
- Fluorescence In Situ Hybridization (FISH)
- Molecular (Biomarker) testing
Management
- Patients with leukemia should be referred to a hematologist-oncologist to initiate treatment.
- Therapy varies significantly based on the leukemia subtype and patient factors.
- Acute leukemias are treated predominantly as an in-patient needing significant support and frequent monitoring.
- Hematopoietic stem cell transplant (HPSCT) or bone marrow transplant is a treatment option.
Learn about the different types of leukemia, including acute and chronic forms, and their classification based on cell origin and proliferation rate.
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