Clinical presentation of acute and chronic leukemias

• Leukemia is malignant neoplasms of the hematopoietic stem cells; the peripheral blood may or may not be involved, but the marrow is always involved (must have > 30% blasts in smear or marrow)

• Acute leukemia

  • Characterized by immature hematopoietic cells (blasts) and a rapidly fatal course if untreated

  • Often associated with anemia, thrombocytopenia, infection (from decreased neutrophil count), and/or bleeding – all manifestations are a result of the accumulation of neoplastic blast cells in the bone marrow that suppress normal hematopoiesis by crowding

  • Abrupt onset, fatigue (due to anemia), F (due to infection), and bleeding (petechiae, ecchymoses, epistaxis, and gingival bleeding) due to thrombocytopenia or DIC (most frequent with AML M3)

  • Bone pain and tenderness due to marrow expansion, bone resorption, and subperiosteal infiltration

  • CNS manifestations from meningeal involvement: H/A, N, V, papilledema, CN palsies, seizure, and even coma; intracerebral or subarachnoid hemorrhages may come form thrombocytopenia and leukostasis and are most often associated with AML

  • WBC count may be decreased, normal, or increased

• Chronic leukemia

  • Mature, yet atypical appearing cells

  • Clinical course often prolonged even without treatment

  • Associated cytopenias appear late in disease

Category: Medical Subject Notes , Pathology Notes