Acute leukemia

Acute Myeloid Leukemia

Background

• aka Acute myelogenous leukemia or non-lymphocytic leukemia
• Most common acute leukemia in adults (around 80% of cases)
• 65yo median age of diagnosis, Male:Female 5:3
• characterized by clonal proliferation of myeloid precursors(blast cells >20% in the periphery)

Diagnosis

• Presents with anemia, neutropenia, thrombocytopenia,
• weakness, easy fatigability, infections, gingival bleeding/enlargement, ecchymoses, epistaxis, menorrhagia

Work-Up

• CXR
• CBC with peripheral smear
• Chem7, ca, mg, phos, Uric Acid, UA, LDH (to check for Tumor Lysis)
• LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen (to check for DIC)
• Get extra purple top for flow cytometry, especially before transfusion

Treatment

• Aggressive IV hydration
• If febrile, complete cultures and broad spectrum antibiotics
• Manage Complications
  • see DIC
  • see Leukostasis
  • see Tumor Lysis Syndrome

Acute Lymphocytic Leukemia

Background

• Characterized by proliferation of immature lymphoblast( >20% in periphery)
• Less than 20% of acute leukemias in adults,
• Most common form in children (see also Leukemia (Peds))
• Highest incidence in 7th decade of life

Diagnosis

• Lymphocytosis, neutropenia, anemia, thrombocytopenia,
• Lymphadenopathy, hepatosplenomegaly
• CNS and testes involvement common

DDX

• Hodgkin and non-Hodgkin lymphomas

Work-Up

• CXR
• CBC with peripheral smear
• Chem7, ca, mg, phos, Uric Acid, UA, LDH (to check for Tumor Lysis)
• LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen (to check for DIC)
• Get extra purple top for flow cytometry, especially before transfusion

Treatment

• Aggressive IV hydration
• If febrile, complete cultures and broad spectrum antibiotics
• Manage Complications
  • see DIC
  • see Leukostasis
  • see Tumor Lysis Syndrome

Source

Uptodate & MKSAP15

See Also

• Oncologic emergencies
• Lymphoma