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Acute Myeloid Leukemias (AML)

Acute Myeloid Leukemias (AML). MLAB 1415: Hematology Keri Brophy-Martinez. Overview of AML. Also known as Acute myelocytic leukemia Acute myelogenous leukemia Acute nonlymphocytic leukemia

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Acute Myeloid Leukemias (AML)

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  1. Acute Myeloid Leukemias (AML) MLAB 1415: Hematology Keri Brophy-Martinez

  2. Overview of AML • Also known as • Acute myelocytic leukemia • Acute myelogenous leukemia • Acute nonlymphocytic leukemia • Stem cell disorder characterized by malignant neoplastic proliferation and accumulation of immature and nonfunctional hematopoietic cells in the BM • Chemo/radiation • Exposure to benzene • History of MDS

  3. Overview of AML • All acute leukemias begin BEFORE clinical signs and symptoms occur • As the tumor volume expands, normal functional marrow cells decrease • Characterized by two major features • Ability to proliferate continuously • Due to mutations affecting growth factors • Transcription errors • Arrested development of normal cells • Lacks apoptosis

  4. Etiology • Classified by the cellular appearance of the primary stem cell • Common myeloid progenitor (CMP) • AML or ANLL • Common lymphoid progenitor (CLP) • ALL • Peak incidence in adults over 60

  5. Clinical findings • CLASSIC TRIAD • Anemia • Infection • Bleeding/easy bruising/petechiae • Fever • Shortness of breath • Fatigue • Weight loss • Pallor

  6. Lab Features: Peripheral blood • WBC count: • variable at diagnosis • ( 1-200 x 109/L) • >20% blasts present • Auer rods: fused primary granules in myeloblasts • RBCs • Decreased • Hgb < 10g/dL • Inclusions reflect rbc maturation defects • Howell-Jolly, Pappenheimer, basophilic stippling • nRBCs present • Platelets • Decreased • Hypogranular, giant forms • Megakaryocyte fragments

  7. Lab Features: MISC. • BONE MARROW • Hypercellular • Decreased fat content • >20 nonerythroid blasts • Fibrosis • MISC • Hyperuricemic • Increased LDH

  8. Who Classification of acute leukemia • AML with recurrent genetic abnormalities • AML with myelodysplasia- related changes • AML and MDS- therapy related • AML- not otherwise categorized

  9. WHO Classification of Acute MyelocyticLeukemias

  10. FAB Classification of Acute Leukemia

  11. M1: AML without maturation • Myeloblast with Auer rod • High N:C ratio • Fine chromatin • Prominent nuclei

  12. M2: Aml with maturation • All stages of neutrophil maturation • >20% myeloblasts • Auer rods common

  13. M3: promyelocytic leukemia (faggot cell) • Faggot cells with bundles of Auer rods • Genetic translocation t(15;17) • Hypergranulation

  14. M4: Acute myelomonocytic leukemia (AMML) • Monoblasts and promonocytes seen • Some neutrophil precursors seen • Vacuolization often seen

  15. M5: Acute monoblastic leukemia • Monoblasts • Promonocytes

  16. M6: Acute erythroid leukemia • Striking poik • High number of RBC precursors • >20 Myeloblasts

  17. M7: Acute Megakaryoblastic Leukemia • Peripheral blood • May see micromegakaryoblasts • Megakaryocyte fragments • Cytopenias • Dysplastic segmented neutrophils and platelets • Bone marrow • Often get “dry tap” • Fibrosis

  18. Prognosis of all AMLs and therapy • Death often occurs from infection and hemorrhage in weeks to months unless therapy is started • Chemotherapy • Reduces tumor load • Bone marrow transplants

  19. References • McKenzie, Shirlyn B., and J. Lynne. Williams. "Chapter 21." Introduction. Clinical Laboratory Hematology. Boston: Pearson, 2010. Print

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