leukemia

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^[1]^[2]^[3]

Genetics

implicated genes (also see more specific type) hemogen, LETMD1, ANKHD1, NUDCD1, XRRA1, DMTF1, CDK6

Clinical manifestations

(signs/symptoms)

fatigue, weakness, lethargy
bleeding
- skin - petechia, purpura
- gums -gingival hypertrophy, oozing
- mucous membranes
- hematuria
- melena
infection - fever, chills
- skin -pyoderma gangrenosum
- throat
- sinus
- gums
- respiratory tract
- urinary tract
CNS symptoms
- headache - meningeal signs
- nausea/vomiting
- blurred vision
- papilledema
- cranial nerve disturbances
- altered mental status
bone pain
gastrointestinal (GI) symptoms
lymphadenopathy
oliguria
obstipation

Laboratory

complete blood count (CBC) with differential
peripheral blood smear
Chemistry profile
leukemia panel by flow cytometry^[3]
coagulation studies
- PT, INR
- PTT
- disseminated intravascular coagulation (DIC) panel
  - fibrinogen in plasma
  - fibrin-split products
blood cultures when appropriate
bone marrow aspirate & biopsy
- histochemical stains
- cytochemical stains
- immunological stains
- phenotyping
- flow cytometry
- karyotypic analysis
Lumbar puncture
- routine CSF analysis
- cytology
- cultures

Differential diagnosis

Marrow failure of AML/ALL vs aplastic anemia
marrow infiltration with nonhematopoietic tumors
- children
  - neuroblastoma
  - rhabdomyosarcoma
- adults
  - Ewing's sarcoma
  - small cell carcinoma
presence of lymphadenopathy or splenomegaly
- infection
  - viral
  - bacterial
  - chlamydial
  - protozoan
  - mycotic
  - rickettsial
  - mycobacterial
  - HIV
- autoimmune
- iatrogenic hypersensitivity
  - serum sickness
  - drug hypersensitivity
- 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]

More general terms

More specific terms

Additional terms

leukemia panel by flow cytometry

References

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 594
↑ ^2.0 ^2.1 The Cancer Genome Atlas Research Network Genomic and Epigenomic Landscapes of Adult De Novo Acute Myeloid Leukemia. N Engl J Med May 1, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23634996 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23634995 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1303816
↑ ^3.0 ^3.1 ARUP Consult: Leukemia/Lymphoma Phenotyping Evaluation by Flow Cytometry https://arupconsult.com/ati/leukemia-lymphoma-phenotyping-evaluation

Patient information

leukemia patient information

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