Acute myeloid leukemia

Background

• AKA Acute myelogenous leukemia or non-lymphocytic leukemia
• Most common acute leukemia in adults (around 80% of cases)
• 65 yo median age of diagnosis, Male:Female 5:3
• Characterized by clonal proliferation of myeloid precursors(blast cells >20% in the periphery)

Clinical Features

• Presents with symptoms of:
  • Anemia: weakness, easy fatigability, SOB
  • Neutropenia: infections
  • Thrombocytopenia: ginvival bleeding/enlargement, ecchymoses, epistaxis, menorrhagia

Differential Diagnosis

Acute Leukemia/Lymphoma

• Acute myeloid leukemia
• Acute lymphocytic leukemia
• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma

Evaluation

• CXR
• CBC with peripheral smear
• Chem7, ca, mg, phos, Uric Acid, UA, LDH (to check for Tumor Lysis)
• LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen (to check for DIC)
• ESR, CRP
• Reticulocyte count in anemia
• Get extra purple top for flow cytometry, especially before transfusion

Treatment

• Aggressive IV hydration
• If febrile, complete cultures and broad spectrum antibiotics
• Manage Complications
  • See DIC
  • See Leukostasis
  • See Hyperviscosity syndrome
  • See Tumor Lysis Syndrome
  • See Retinoic acid syndrome

See Also

• Oncologic emergencies
• Acute leukemia

References

• Janz TG, Hamilton GC: Anemia, Polycythemia and White Blood Cell Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 121:p 1586-1605.

Authors

Claire