Leukemia
Revision as of 01:28, 1 October 2019 by ClaireLewis (talk | contribs)
Background
- Hematologic malignancy that typically originates in bone marrow and results in high number of abnormal leukocytes or blasts
Types of Leukemia
- Acute myeloid leukemia
- Chronic myeloid leukemia
- Acute lymphocytic leukemia
- Chronic lymphocytic leukemia
- Leukemia (peds)
Clinical Features
- Varies by type
Complications
- Tumor lysis syndrome
- Neutropenic fever, Sepsis, overall increased risk of infection
- Leukostasis and hyperleukocytosis
- Hyperviscosity syndrome
- Thromboembolism
- Treatment-related complications
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
Differential Diagnosis
Leukocytosis
- Normally responding bone marrow
- Infection
- Inflammation: tissue necrosis, infarction, burns, arthritis
- Stress: overexertion, seizures, anxiety, anesthesia
- Drugs: corticosteroids, lithium, beta agonists
- Trauma: splenectomy
- Hemolytic anemia
- Leukemoid malignancy
- Abnormal bone marrow
Workup Consideration
- CXR
- CBC with peripheral smear
- Tumor lysis syndrome labs: chem7, ca, mg, phos, uric acid, UA, LDH
- DIC labs: LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen
- ESR, CRP
- Reticulocyte count in anemia
- Get extra purple top for flow cytometry, especially before transfusion
Management
- Address any complications
- Consult oncology for new diagnosis