Difference between revisions of "Chronic myeloid leukemia"

(Differential Diagnosis)
 
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==Background==
 
==Background==
*aka chronic myelogenous leukemia, chronic myelocytic leukemia
+
*Also known as chronic myelogenous leukemia, chronic myelocytic leukemia
 
*More common in older patients
 
*More common in older patients
  
 
==Clinical Features==
 
==Clinical Features==
*Usually progresses through 3 stages:
+
''Usually progresses through 3 stages''
*Chronic phase
+
 
**Asymptomatic or indolent, nonspecific symptoms
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===Chronic phase===
**Malaise, fatigue, weight loss, low grade fever
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*Asymptomatic or indolent, nonspecific symptoms
**Lymphadenopathy, splenomegaly
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*Malaise, [[fatigue]], weight loss, low grade [[fever]]
*Accelerated phase
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*[[Lymphadenopathy]], splenomegaly
**Worsening of above symptoms due to progressive leukocytosis
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**Signs/symptoms of [[thrombocytopenia]] (e.g. petechiae, bleeding) or thrombocytosis
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===Accelerated phase===
*Blast crisis
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*Worsening of above symptoms due to progressive [[leukocytosis]]
**Behaves like [[acute leukemia]]
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*Signs/symptoms of [[thrombocytopenia]] (e.g. [[petechiae]], [[hemorrhage|bleeding]]) or [[thrombocytosis]]
**Associated with [[Leukostasis and hyperleukocytosis]] and [[Hyperviscosity syndrome]]
+
 
 +
===Blast crisis===
 +
*Behaves like [[acute leukemia]]
 +
*Associated with [[Leukostasis and hyperleukocytosis]] and [[Hyperviscosity syndrome]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Oncologic emergencies DDX}}
 
{{Oncologic emergencies DDX}}
 +
{{DDX leukocytosis}}
  
 
==Evaluation==
 
==Evaluation==
*CBC-
+
*CBC
**Leukocytosis: usually only moderately elevated in chronic phase (20,000-60,000)
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**[[Leukocytosis]]: usually only moderately elevated in chronic phase (20,000-60,000)
 
**Mild-moderate [[anemia]]
 
**Mild-moderate [[anemia]]
 
**Variable platelet counts
 
**Variable platelet counts
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==Management==
 
==Management==
*See management of [[Leukostasis and hyperleukocytosis]], [[neutropenic fever]], [[hyperviscosity syndrome]], [[tumor lysis syndrome]], [[thrombocytopenia]]
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*See management of [[Leukostasis and hyperleukocytosis]], [[neutropenic fever]], [[hyperviscosity syndrome]], [[DIC]], [[tumor lysis syndrome]], [[thrombocytopenia]], [[anemia]]
  
 
==Disposition==
 
==Disposition==
 +
*Can consider discharging asymptomatic patients in chronic phase who have no complications and close follow-up. Otherwise, admit.
  
 
==See Also==
 
==See Also==

Latest revision as of 00:11, 1 October 2019

Background

  • Also known as chronic myelogenous leukemia, chronic myelocytic leukemia
  • More common in older patients

Clinical Features

Usually progresses through 3 stages

Chronic phase

Accelerated phase

Blast crisis

Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

Leukocytosis

Evaluation

  • CBC
    • Leukocytosis: usually only moderately elevated in chronic phase (20,000-60,000)
    • Mild-moderate anemia
    • Variable platelet counts
  • Peripheral smear
  • DIC labs: coags, d-dimer, fibrinogen
  • Tumor lysis syndrome labs: BMP, uric acid, phosphate
  • Infectious workup
  • Evaluate for complications

Management

Disposition

  • Can consider discharging asymptomatic patients in chronic phase who have no complications and close follow-up. Otherwise, admit.

See Also

External Links

References