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Hematology Pathology - 004) Acute Myelogenous Leukemia (AML) (Illustrations - Key)

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PATHOPHYSIOLOGY DIAGNOSTIC APPROACH

Hematopoiesis Pathway Effects of ↑↑ Myeloblasts in Bone Marrow CBC w/ P.B.S. Immunophenotyping

↓↓RBC’s Myeloperoxidase
↑↑ Myeloblasts (2/2 ↓Space) M.P.O.
Hemocytoblast ↓↓PLTs
↓↓Functional WBC’s
↑↑Risk of Infections ↑ Immunohistochemistry Flow Cytometry
PNA pneumonia Variable WBC’s
myeloid lymphoid ↓
stem cells stem cells ↑↑Mortality
M.S.C. L.S.C.
RBC
↑↑Myeloblasts M.P.O. (+) → AML N/A
↓↓ Anemia (↓Space)

↑↑↑
↑↑↑
P.B.S. Auer rods (APL)
Fatigue, Pallor, Dyspnea
TREATMENT
peripheral blood smear
PLT
↓↓ Thrombocytopenia (↓Space) UTI
RBC PLT Myeloblast ↑↑ Lymphoblast Bone Marrow Biopsy
Bruising, Bleeding
Definitive Diagnosis Chemotherapy: AML (non APL Subtype)
promyelocyte ↑↑Myeloblasts
Expands Bone Marrow
P.M.C. B-lymphocytes Induction → Consolidation → Maintenance
T-lymphocytes Bone Pain Cellulitis
>20% Myeloblasts Agents

Auer rods (APL) Cytarabine


Ida/daunorubicin
Neutrophils Eosinophils Basophils
Effects of ↑↑ Myeloblasts in Blood and Tissues

Tests of Complications Chemotherapy: AML (APL Subtype)


Granulocytes

Promote Differentiation
(≥100K) Disseminated intravascular coagulation DIC
Causes of ↑↑ Myeloblasts Myeloblast → P.M.C. → Granulocyte
Leukostasis Cutaneous/Mucosal DIC (APL)
Agents
ATRA
1 AML ALL Leukemia Cutis
Chemoradiation (M/C) Tissue ± Arsenic Trioxide
H.C.B. Gingival Hyperplasia plasminogen
activator ↑PIT ↑INR ↓Fibrinogen ↑D-Dimer ↓PLTs ↓RBC’s
↑↑DNA H/A ↑TPA ↑Tissue
Factor Bone Marrow Transplant
Mutation Replication TIA Tumor Lysis Syndrome
↑↑Fibrinolysis (III) T.L.S.
CVA ↑↑K+ AML (Poor prognostic findings)
M.S.C. L.S.C.
2 AKI
M/C ↑↑Bleeding ↑↑Clotting
Genetic Dx
3-
↑↑PO4 + Ca2+ ↑Cr AML (Failed chemotherapy)
• 2/2 Chemotherapy Risk Crystals
↓↓Clotting ↑↑Uric Acid ↑BUN
Down Syndrome Dyspnea L/C
(Trisomy 21) • Spontaneous Factors ↓↓Ca 2+ Complications
Myeloblast ↑↑
acute promyelocytic leukemia Hypoxemia 2/2 ↑↑ Tumor Burden
(2/2 Consumption)
AML Subtype (APL)
(↑↑Myeloblasts )
15;17 translocation Leukostasis Tumor Lysis Syndrome
PML-RAR-α
Genetic Studies
ICH inter cerbral
P.M.C. Vision Ca2+ Cytoreduction
hemorrhage

Changes ↑K+
3 Cytogenetics PCR
3 IVF
Bone Marrow Disorder ↑PO
3- Hydroxyurea
Vision Loss 4

↑Uric Acid Crystals Pulmonary Leukapheresis * ↑Purines 1


MDS →→→ AML Hemorrhage
AKI Allopurinol
Chemotherapy
acute kidney injury
CML →→→ 15;17 ↓Uric Acid
↓UOP ↓AKI
Granulocytes chronic myeloid 2 (toxic)
leukemia ↑Cr Bruising Rasburicase
Bleeding 15;17 translocation (+) PML-RAR-α (+)
↑BUN ↑Allantoin
myelodysplastic syndrome (non-toxic)
APL APL

ACUT E MYELOGENOUS LEUKEMIA

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