Leukemia - Revision history

Aidan: /* Investigations */

2020-07-30T15:47:11Z

Investigations

← Older revision		Revision as of 15:47, 30 July 2020
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	== Clinical Manifestations ==		==Clinical Manifestations==

	*Often cytopenia-related symptoms		*Often cytopenia-related symptoms, including [[anemia]], [[leukopenia]], and [[thrombocytopenia]]
			*May also present with [[DIC]], [[tumour lysis syndrome]], or [[leukostasis]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Rule out [[DIC]] (especially seen in [[APL]])		*Rule out [[DIC]] (especially seen in [[APL]])

	==== [[Tumour lysis syndrome]] ====		====[[Tumour lysis syndrome]]====

	*2 or more: [[hyperkalemia]], [[hyperphosphatemia]], [[hypocalcemia]], [[hyperuricemia]]		*2 or more: [[hyperkalemia]], [[hyperphosphatemia]], [[hypocalcemia]], [[hyperuricemia]]
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	*Do NOT treat [[hypocalcemia]]		*Do NOT treat [[hypocalcemia]]

	==== [[Leukostasis]] ====		====[[Leukostasis]]====

	*More common in [[AML]] than any other		*More common in [[AML]] than any other
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	**No evidence for [[leukopheresis]]		**No evidence for [[leukopheresis]]

	==== Suspected [[APL]] ====		====Suspected [[APL]]====

	*Consult Hematology overnight		*Consult Hematology overnight
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	===Chronic===		===Chronic===

	==== AML ====		====AML====

	*Induction with 3+7: 3 days of daunorubicin and 7 days of cytarabine, includes about a month as inpatient		*Induction with 3+7: 3 days of daunorubicin and 7 days of cytarabine, includes about a month as inpatient
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	**High/poor risk: 1-2 more cycles, then alloSCT		**High/poor risk: 1-2 more cycles, then alloSCT

	==== APL ====		====APL====

	*ATRA + arsenic trioxide		*ATRA + arsenic trioxide

	==== ALL ====		====ALL====

	*Dana-Farber protocol		*Dana-Farber protocol

Aidan: restructured

2020-07-30T15:44:06Z

restructured

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-== Differential Diagnosis ==
+== Clinical Manifestations ==
-=== Acute ===
+==== APL ====
-=== Chronic ===
+==== ALL ====
 [[Category:Hematology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-20T14:23:08Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 14:23, 20 July 2020
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	** Cigarette smoking		** Cigarette smoking

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* History		* History

Maintenance script: Imported from text file

2020-07-04T01:17:42Z

Imported from text file

New page

== Differential Diagnosis ==

* Primary: suspect when multiple lineages affected, significant leukocytosis, lymphadenopathy, splenomegaly
* Secondary
** Acute infection (30-50s)
** Chronic inflammation
** Stress (MI, surgery, burn) (30-50)
** Steroids
** Pregnancy
** Cigarette smoking

== Clinical Presentation ==

* History
** Often cytopenia-related symptoms
* Signs & Symptoms

== Investigations ==

* Labs
** Urgent blood film review to r/o APL
* Imaging
* Other

== Management ==

=== Acute ===

* DIC (especially seen in APL)
* Tumour lysis syndrome
** 2 or more: hyperkalemia, hyperphsphatemia, hypocalcemia, hyperuricemia
** causes renal dysfunction, seizures, arrhythmias
** Hydration with IVNS (don't supplement electrolytes), target urine output of 80-100 mL/m2/h
** Rasburicase to get rid of uric acid (may need to call nephrology)
** Treat hyperkalemia
** Do NOT treat hypocalcemia
* Leukostasis (in AML more than any other)
** Lungs and brain most commonly affected
** Cytoreduction
*** Induction chemotherapy as soon as possilble
*** Overnight, give hydroxyurea 2g q6h
**** Can develop tumour lysis syndrome
*** No evidence for leukopheresis
* APL is suspected
** Consult heme/onc overnight
** Start ATRA 45mg/m2 divided BID
** Beware differentiation syndrome, with fever, effusion, dyspnea, hypotension; treated with steroids
** Beware DIC
*** Follow q6h bloodwork
*** Transfuse platelets ≥ 30
*** Cryoprecipitate to keep fibrinogen ≥ 1.5 (regardless of bleeding)
*** Plasmia to keep INR < 1.5
*** AVOID tranexamic acid

=== Chronic ===

* AML
** Induction with 3+7: 3 days of daunorubicin and 7 days of cytarabine, includes about a month as inpatient
** BM to confirm induction, then consolidation
*** Low risk: 2-3 more cycles of same
*** High/poor risk: 1-2 more cycles, then alloSCT
* APL
** ATRA + arsenic trioxide
* ALL
** Dana-Farber protocol
** 2+ years of chemo + steroids
** For Philadelphia positive disease, add imatinib

[[Category:Hematology]]
[[Category:Oncology]]