Leukemia: Difference between revisions

Latest revision as of 23:31, 28 November 2019

This page is for adult patients. For pediatric patients, see: leukemia (peds)

Background

Hematologic malignancy that typically originates in bone marrow and results in high number of abnormal leukocytes or blasts

Types of Leukemia

Myeloid and Lymphoid lineage

Clinical Features

Varies by type

Complications

Tumor lysis syndrome
Neutropenic fever, Sepsis, overall increased risk of infection
- Neutropenic enterocolitis (typhlitis)
Leukostasis and hyperleukocytosis
Hyperviscosity syndrome
Thromboembolism
Treatment-related complications
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
  - Exit site infection
  - CVC obstruction (intraluminal or catheter tip thrombosis)
  - Catheter-related venous thrombosis
  - Fracture of catheter lumen

Differential Diagnosis

Leukocytosis

Normally responding bone marrow
- Infection
- Inflammation: tissue necrosis, infarction, burns, arthritis
- Stress: overexertion, seizures, anxiety, anesthesia
- Drugs: corticosteroids, lithium, beta agonists
- Trauma: splenectomy
- Hemolytic anemia
- Leukemoid malignancy
Abnormal bone marrow
- Acute leukemia
  - Acute myeloid leukemia
  - Acute lymphocytic leukemia
- Chronic leukemia
  - Chronic myeloid leukemia
- Myeloproliferative disorders

Workup Consideration

CXR
CBC with peripheral smear
Tumor lysis syndrome labs: chem7, ca, mg, phos, uric acid, UA, LDH
DIC labs: LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen
ESR, CRP
Reticulocyte count in anemia
Get extra purple top for flow cytometry, especially before transfusion

Management

Address any complications
Consult oncology for new diagnosis

@@ Line 1: / Line 1: @@
-#REDIRECT[[Acute leukemia]]
+{{Adult top}} [[leukemia (peds)]]
+==Background==
+*Hematologic malignancy that typically originates in bone marrow and results in high number of abnormal leukocytes or ''blasts''
+===Types of Leukemia===
+*[[Acute myeloid leukemia]]
+*[[Chronic myeloid leukemia]]
+*[[Acute lymphocytic leukemia]]
+*[[Chronic lymphocytic leukemia]]
+*[[Leukemia (peds)]]
+[[File:Celldifferentiation.jpg|thumbnail|Myeloid and Lymphoid lineage]]
+==Clinical Features==
+*Varies by type
+===Complications===
+*[[Tumor lysis syndrome]]
+*[[Neutropenic fever]], [[Sepsis]], overall increased risk of [[infection]]
+**[[Neutropenic enterocolitis (typhlitis)]]
+*[[Leukostasis and hyperleukocytosis]]
+*[[Hyperviscosity syndrome]]
+*[[Thromboembolism]]
+*Treatment-related complications
+**Chemotherapy-induced [[nausea and vomiting]]
+**[[Cytokine release syndrome]]
+**Chemotherapeutic drug extravasation
+**[[Differentiation syndrome]] ([[retinoic acid syndrome]]) in APML
+**[[Stem cell transplant complications]]
+**Catheter-related complications
+**Tunnel infection
+***Exit site infection
+***CVC obstruction (intraluminal or catheter tip thrombosis)
+***Catheter-related venous thrombosis
+***Fracture of catheter lumen
+==Differential Diagnosis==
+{{DDX leukocytosis}}
+==Workup Consideration==
+*[[CXR]]
+*CBC with peripheral smear
+*[[Tumor lysis syndrome]] labs: chem7, ca, mg, phos, uric acid, [[UA]], LDH
+*[[DIC]] labs: [[LFTs]], Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen
+*ESR, CRP
+*Reticulocyte count in anemia
+*Get extra purple top for flow cytometry, especially before transfusion
+==Management==
+*Address any complications
+*Consult oncology for new diagnosis
+==See Also==
+*[[Oncologic emergencies]]
+*[[Lymphoma]]
+[[Category:Heme/Onc]]