Step II Trouble Differentiating Leukemias

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Haybrant

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I find differentiating leukemia's based on the questions difficult. Any future oncologists out there wish to help out.

FA clumps the acute and the chronics together which makes it tough to tease out what what is unique but i think im having trouble w the overall picture. Some of them have overcrowding of the BM which spills into circulation? Some have thrombocytosis, some dont. some show granulocyte excess, some show immature forms?

Thanks for the help!
 
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Acute leukemias :
patient with fatigue bleeding infections.
peripheral smear showing blasts.
most important prognostic finding is cytogenetic abnormality.
Auer rods are associated with AML
M3 acute promyelocytic leukemia has highest mortality since it's associated with DIC. Treat this with ALTRA (all trans retinoic acid)
chemo with idarubicin and cytosine arabinoside is the best initial therapy.
Add intrathecal methotrexate for ALL

CML
elevated white count thats predominantly neutrophil.
Splenomegaly is frequent: pt has LUQ pain, early satiety
Itching is common since basophils will release histomine.
Low Lekocyte Alk phos score.
Rx: imatibib

CLL
patients over 50, elevated white count thats described as normal appearing lymphocytes. Often asymtomatic and found on routine screening
peripheral smear shows smudge cells .
rx: fludrabine and chlorambucil

Hairy cell
pancytopenia
middle aged patient
massive splenomegaly
Dx with TRAP
Rx: cladribine or 2-CDA

Myelofibrosis
same presentation as hairy cell but TRAP is normal
tear shaped cells on smear.
Rx: thalidomide or linalidomide
 
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One more thing

mYelodysplasia

pancytopenia
elevated MCV
low retics
and macroovalocytes
bilobed neutrophils (pelget huer cells)
small number of blasts but not enough to be considered leukemia
it may progress to acute leukemia but most patients die from infection and bleeding
 
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Yeah, that was a nice little summary, thanks for that. I took step 2 yesterday and I think I only had 1 leukemia question on the whole thing. Nailed it though, thanks again
 
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