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68 Cards in this Set
- Front
- Back
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what are the leukemias
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cancers of the WBCs involving bone marrow circulating WBCs and spleen/lymph nodes
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what are pluripotent stem cells
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most primative cells
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what will pluripotent stem cells differentiate into
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either myeloid/lymphoid stem cells- mature B cells/lymphocytes come from these
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what do myeloid stem cells produce
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progenitors
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what do progenitors lead to
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production of mature functional cells
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what are the acute leukemias
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AML, ALL
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what are the categories of AML
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M: 0-7
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what are the categories of ALL
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L:1-3
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what are the chronic leukemias
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CML, CLL
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what is the patho of acute leukemia
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progresses quickly, proliferation of immature cells
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what is the patho of chronic leukemia
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slow progression, uncontrolled expansion of mature cells
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what are the categories of acute/chronic leukemia
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myelogenous/lymphocytic
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what does myelogenous leukemia affect
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granulocytes/monocytes
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what does lymphocytic leukemia affect
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lymphocytes
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what do the symptoms of leukemias result from
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interference w/ normal processes
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where do leukemic cells accumulate
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in bone marrow
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what does the accumulation of leukemic cells in b.m. cause
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hampered production of normal blood cells/decreased counts
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what does the decreased counts of normal blood cells cause
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anemia thrombocytopenia neutropenia
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what does anemia thrombocytopenia neutropenia cause
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fatique pallor bleeding infection
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what are the signs/symptoms of leukemias
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cervical adenopathy, nontender lymphadenopathy, mediastinal adenopathy, t cell mediated immune deficiency,
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what % of cervical adenopathy is seen
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80-90%
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nontender lymphadenopathy is seen in what areas
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neck, supraclavicular area, axilla
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mediastinal adenopathy is seen in what %
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more 50% at dx
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t cell mediated immune deficiency is seen when
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even in early stage dz
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t cell mediated immune deficiency causes what
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prone to infection: herpes zoster 1/4 pt, fungal/mycobacterial infections
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what pattern is the immune defect after the leukemia is cured
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may still persist
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what is the etiology of ALL
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unknown
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what is the possible cause of ALL
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ionizing radiation (atomic bomb survivors-1015% increase, hydrocarbons, benzene, alkylating agents- cyclophosphamide, naturally occuring retrovirus/human t cell lymphotrophic virus
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what is the hereditary pattern of ALL
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identical twin 20% likeliness, down syndrome 15-20% increase risk
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what is ALL characterized by
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proliferation of lymphoblasts
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what does the overproduction of lymphoblasts in ALL do
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limits production of other cells by overcrowding/inhibits cell growth and differentiation
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how many ppl are affected by ALL
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5/100,000 ppl
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what is most common pediatric cancer
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ALL
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how many children w/ acute leukemia have ALL
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80%
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when is the peak incidence for ALL
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b/w 2-6 yrs old
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ALL is more common in who
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males, whites, Jews
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where do leukemic cells accumulate in ALL
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bone marrow
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what do the decreased counts in ALL cause
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anemia, thrombocytopenia, neutropenia
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what are the main symptoms of ALL
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fatique pallor bleeding infection
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what are some common symptoms of ALL
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liver, splenic, testicular enlargement; swollen joints, bone pain, tenderness,limping/not walking, CNS-vomitting, headache, papilledema, nick stiffness cranial nerve palsy
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what will swollen joints, bone pain, and tenderness mimic in ALL
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rheumatoid arthritis
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when do ALL symptoms occur
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rarely more than 6 weeks before dx
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what will neutropenia cause in ALL
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infection, respiratory, dental, sinus, perirectal, uti problems
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what are the diagnostics done for ALL
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B count, immunophenotyping, bone marrow bx,
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what will the b count reveal in ALL
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thrombocytopenia, anemia 2/3 at diagnosis; WBC vary
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what does abnormal in in WBC mean in ALL
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poor prognosis
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what will the immunophenotyping show in ALL
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morphological evaluation, special stains, electron microscopy, surface markers, establish dx 90% cases
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what will a bone marrow bx do for ALL
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determine amount of leukemic blast- >25% positive for leukemia
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what other abnormalities are seen in ALL
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hyperuricemia, hypomagnesemia, hypocalcemia, hypercalcemia
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what % pt have low serum levels of immunoglobulins
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30%
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what are immunoglobulins
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proteins that act as anitbodies
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what can have leukemic infiltrates in ALL
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liver, periosteum, bone
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what mass may be present in ALL
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mediastinal - in high risk pt
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what are the 2 most common sites for extramedullary leukemia in ALL
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CNS, testes
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what is staging based on
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FAB system
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what does the FAB system classify by
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cell size, nuclear shape, number nuclei, prominence of nuclei, amount of cytoplasm
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what are the levels of the FAB
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L1-3 3=worse
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what class are majority of pediatric ALL pt
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L1
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what % ALL pt are categorized by t cell, b cell, or pre b cell markers
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25%
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what % of ALL pt are categorized by null cell type
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70%
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what does null cell type react to
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antibody made from antigen found in ALL cells: antigen is called CALLA or common leukemia associated antigen
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what are the characteristics of L1 in ALL
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25-30% of adult cases, blasts small, uniform, high nuclear to cytoplasmic ratio, t or pre b cell
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what are the characteristics of L2 in ALL
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70% most cases, most common, blasts large, heterogenous, lower nuclear to cytoplasmic ratio, null cell
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what are the characteristics of L3 in ALL
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1-2% adult cases, vacuolated blasts, basophilic cytoplasm, b cell
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what is the acure Tx plan for ALL
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alone or in comb: radiation therapy, TBI, brain/testes/CNS(CSI) tx w/ radiation- dep. on involvement, chemo, bone marrow transplant
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what techniques are used for radiation therapy in ALL
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varied
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how is chemo done in ALL
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3 stages of drugs: induction, consolidation, maintenance: protocols change/vary by institution
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how is bone marrow transplant done in ALL
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no longer experiemtal for certain dx and is tx of choice for ALL AML and CML
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