PATHOPHYSIOLOGY DIAGNOSTIC APPROACH

Hematopoiesis Pathway Effects of ↑↑ Myeloblasts in Bone Marrow CBC w/ P.B.S. Immunophenotyping

↓↓RBC’s
↑↑ Myeloblasts (2/2 ↓Space) M.P.O.
Hemocytoblast ↓↓PLTs
↓↓Functional WBC’s
↑↑Risk of Infections ↑ Immunohistochemistry Flow Cytometry
PNA Variable WBC’s
↓
↑↑Mortality
M.S.C. L.S.C. ↑↑Myeloblasts M.P.O. (+) → AML N/A
↓↓ Anemia (↓Space)

↑↑↑
↑↑↑
P.B.S. Auer rods (APL)
Fatigue, Pallor, Dyspnea

RBC PLT Myeloblast ↑↑ Lymphoblast

↓↓ Thrombocytopenia (↓Space) UTI
Bone Marrow Biopsy
TREATMENT
Bruising, Bleeding
Definitive Diagnosis Chemotherapy: AML (non APL Subtype)
↑↑Myeloblasts
Expands Bone Marrow
P.M.C. B-lymphocytes Induction → Consolidation → Maintenance
T-lymphocytes Bone Pain Cellulitis
>20% Myeloblasts Agents

Auer rods (APL) Cytarabine

Ida/daunorubicin
Neutrophils Eosinophils Basophils
Effects of ↑↑ Myeloblasts in Blood and Tissues

Tests of Complications Chemotherapy: AML (APL Subtype)

Granulocytes

Promote Differentiation
(≥100K) DIC
Causes of ↑↑ Myeloblasts Myeloblast → P.M.C. → Granulocyte
Leukostasis Cutaneous/Mucosal DIC (APL)
Agents
ATRA
1 AML ALL Leukemia Cutis
Chemoradiation (M/C) ± Arsenic Trioxide
H.C.B. Gingival Hyperplasia
↑PIT ↑INR ↓Fibrinogen ↑D-Dimer ↓PLTs ↓RBC’s
↑↑DNA H/A ↑TPA ↑Tissue
Factor Bone Marrow Transplant
Mutation Replication TIA Tumor Lysis Syndrome
↑↑Fibrinolysis (III) T.L.S.
CVA ↑↑K+ AML (Poor prognostic findings)
M.S.C. L.S.C.
2 AKI
M/C ↑↑Bleeding ↑↑Clotting
Genetic Dx
3-
↑↑PO4 + Ca2+ ↑Cr AML (Failed chemotherapy)
• 2/2 Chemotherapy Risk Crystals
↓↓Clotting ↑↑Uric Acid ↑BUN
Down Syndrome Dyspnea L/C
(Trisomy 21) • Spontaneous Factors ↓↓Ca 2+ Complications
Myeloblast ↑↑
Hypoxemia 2/2 ↑↑ Tumor Burden
(2/2 Consumption)
AML Subtype (APL)
(↑↑Myeloblasts )
15;17 translocation Leukostasis Tumor Lysis Syndrome
PML-RAR-α
Genetic Studies
ICH
P.M.C. Vision Ca2+
↑K+ Cytoreduction
3 Changes 3 IVF
Cytogenetics PCR Hydroxyurea
↑PO
3-
Bone Marrow Disorder Vision Loss 4

↑Uric Acid Crystals Pulmonary Leukapheresis * ↑Purines 1

MDS →→→ AML Hemorrhage
AKI Allopurinol
CML →→→ Chemotherapy
↓UOP 15;17 ↓Uric Acid ↓AKI
Granulocytes 2 (toxic)
↑Cr Bruising Rasburicase
Bleeding 15;17 translocation (+) PML-RAR-α (+)
↑BUN ↑Allantoin
(non-toxic)
APL APL

ACUT E MYELOGENOUS LEUKEMIA