0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
38 Acute Myeloblastic LeukemiaSigns & Symptoms
■May be asymptomatic
■Fever, fatigue, bruising, gum bleeding, weight loss, rash
■Less common – headache, confusion, frank bleeding
■Pallor, petechiae, leukemia cutis, swollen gums, retinal hemor-
rhages, signs of infection, lymphadenopathy
■Extramedullary mass (myeloblastoma) – skin, bone, paravertebral,
intraspinal
■Less common – jaundice, splenomegaly, CNS signs
tests
Laboratory
Basic Studies:
■Blood: CBC, platelets, blood smear,
■Electrolytes (elevated K+may be spurious if WBC is high)
■Metabolic screen, liver and renal function tests, uric acid
■Coagulation tests: PT, PTT, fibrinogen
■Infection: if febrile, blood, urine, throat, stool cultures (fungal infec-
tions uncommon at presentation, non-infectious fever common)
■Urinalysis
■Specific Diagnostic Tests: bone marrow aspirate and biopsy for mor-
phology and cytochemistry, cytogenetics, immunophenotype by
flow cytometry
➣Important to identify Acute Promyelocytic Leukemia (APL;M3)
➣Cytogenetics is a major predictor of outcome:
Good risk: t(15;17), t(8;21), normal
Poor risk: 11q23 abnormalities,−7,−5,+8, complex karyotype,
mutations in FLT3
■Other Tests as Appropriate: CXR, lumbar puncture, cardiac scan if
prior anthracycline use
differential diagnosis
■Acute infection, leukemoid reactions, megaloblastic anemias,
myelodysplasia distinguished by bone marrow examination
■Cytopenias can be caused by aplastic anemia, ITP, severe infections,
drug reactions, marrow failure syndromes, etc.
management
What to Do First
■General Measures: While confirming diagnosis, start hydration, cor-
rect electrolytes, treat infection, start allopurinol
■Correct anemia with red blood cell transfusions