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Slide 1 - Chapter 24 Acute Myeloid Leukemias (AML) MLAB 1415: Hematology Keri Brophy-Martinez
Slide 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 Neoplastic cells show increased proliferation and/or decreased cell death(apoptosis) Effect is expansion of the neoplastic clone with a decrease in normal cells
Slide 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
Slide 4 - eTIOLOGY Classified by the cellular appearance of the primary stem cell Common myeloid progenitor (CMP) AML or ANLL Common lymphoid progenitor (CLP) ALL
Slide 5 - Clinical findings CLASSIC TRIAD Anemia Infection Bleeding/easy bruising/petechiae Fever Shortness of breath Fatigue Weight loss
Slide 6 - Lab Features: peripheral blood WBC count: variable at diagnosis ( 1-100 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
Slide 7 - Myeloblast with Auer rods
Slide 8 - Lab Features: bone marrow Hypercellular Decreased fat content >20 nonerythroid blasts Fibrosis
Slide 9 - FAB Classification of acute leukemia
Slide 10 - Who Classification of acute leukemia AML with recurrent genetic abnormalities AML with multilineage dysplasia AML and MDS- therapy related AML- not otherwise categorized
Slide 11 - WHO Classification of Acute Myelocytic Leukemias
Slide 12 - M1: AML without maturation Myeloblast with Auer rod High N:C ratio Fine chromatin Prominent nuclei
Slide 13 - M2: Aml with maturation All stages of neutrophil maturation >20% myeloblasts Auer rods common
Slide 14 - M3: promyelocytic leukemia (faggot cell) Faggot cells with bundles of Auer rods Genetic translocation t(15;17) Hypergranulation
Slide 15 - M4: Acute myelomonocytic leukemia (AMML) Monoblasts and promonocytes seen Some neutrophil precursors seen Vacuolization often seen
Slide 16 - M5: Acute monoblastic leukemia Monoblasts Hemophagocytosis Nuclear lobulation
Slide 17 - M6: Acute erythroid leukemia Striking poik High number of RBC precursors >20 Myeloblasts
Slide 18 - Peripheral blood May see micromegakaryoblasts Megakaryocyte fragments Cytopenias Dysplastic segmented neutrophils and platelets Bone marrow Often get “dry tap” Fibrosis M7: Acute Megakaryoblastic Leukemia
Slide 19 - 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
Slide 20 - References McKenzie, Shirlyn B., and J. Lynne. Williams. "Chapter 21." Introduction. Clinical Laboratory Hematology. Boston: Pearson, 2010. Print