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leukemia
Clinical manifestations: (signs/symptoms)
1) fatigue, weakness, lethargy
2) bleeding
a) skin - petechia, purpura
b) gums -gingival hypertrophy, oozing
c) mucous membranes
d) hematuria
e) melena
3) infection - fever, chills
a) skin -pyoderma gangrenosum
b) throat
c) sinus
d) gums
e) respiratory tract
f) urinary tract
4) CNS symptoms
a) headache - meningeal signs
b) nausea/vomiting
c) blurred vision
d) papilledema
d) cranial nerve disturbances
e) altered mental status
5) bone pain
6) gastrointestinal (GI) symptoms
a) abdominal distension
b) nausea/vomiting
c) anorexia - weight loss
d) hepatosplenomegaly
e) abdominal distension
7) lymphadenopathy
8) oliguria
9) obstipation
Genetics:
- implicated genes (also see more specific type) hemogen, LETMD1, ANKHD1, NUDCD1, XRRA1, DMTF1, CDK6
Laboratory:
1) complete blood count (CBC) with differential
2) peripheral blood smear
3) Chemistry profile
a) electrolytes
b) serum Ca+2
c) serum Mg+2
d) serum phosphate
e) serum uric acid
f) liver function tests
g) serum urea nitrogen
h) serum creatinine
4) leukemia panel by flow cytometry [3]
5) coagulation studies
a) PT, INR
b) PTT
c) disseminated intravascular coagulation (DIC) panel
1] fibrinogen in plasma
2] fibrin-split products
6) blood cultures when appropriate
a) aerobic culture
b) anaerobic culture
c) viral culture
d) fungal culture
7) bone marrow aspirate & biopsy
a) histochemical stains
b) cytochemical stains
c) immunological stains
d) phenotyping
e) flow cytometry
f) karyotypic analysis
8) Lumbar puncture
a) routine CSF analysis
b) cytology
c) cultures
Differential diagnosis:
1) Marrow failure of AML/ALL vs aplastic anemia
2) marrow infiltration with nonhematopoietic tumors
a) children
- neuroblastoma
- rhabdomyosarcoma
b) adults
- Ewing's sarcoma
- small cell carcinoma
3) presence of lymphadenopathy or splenomegaly
a) infection
- viral
- bacterial
- chlamydial
- protozoan
- mycotic
- rickettsial
- mycobacterial
- HIV
b) autoimmune
- rheumatoid arthritis
- lupus
- mixed connective tissue disease
- Sjogren's syndrome
c) iatrogenic hypersensitivity
- serum sickness
- drug hypersensitivity
d) potentially malignant entities
- angioimmunoblastic lymphadenopathy
- Castleman's disease (angiofollicular lymph node hyperplasia)
Management:
- varies with type of leukemia
- genetic classification of leukemias may better estimate prognosis & facilitate treatment [2]
Interactions
disease interactions
Related
leukemia markers in blood
leukemia panel by flow cytometry
Specific
acute leukemia
chronic leukemia
leukemia cutis
lymphoid leukemia
meningeal leukemia
myeloid leukemia
plasmacytic leukemia
therapy-related leukemia
General
bone marrow disease
hematologic malignancy (hematopoietic malignancy, hematologic cancer)
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 594
- The Cancer Genome Atlas Research Network
Genomic and Epigenomic Landscapes of Adult De Novo Acute
Myeloid Leukemia.
N Engl J Med May 1, 2013
PMID: 23634996
http://www.nejm.org/doi/full/10.1056/NEJMoa1301689
- Steensma DP
The Beginning of the End of the Beginning in Cancer Genomics.
N Engl J Med May 1, 2013
PMID: 23634995
http://www.nejm.org/doi/full/10.1056/NEJMe1303816
- ARUP Consult:
Leukemia/Lymphoma Phenotyping Evaluation by Flow Cytometry
https://arupconsult.com/ati/leukemia-lymphoma-phenotyping-evaluation