Acute lymphocytic leukemia
Background
- Characterized by proliferation of immature lymphoblast( >20% in periphery)
- Less than 20% of acute leukemias in adults,
- Most common form in children (see also Leukemia (Peds))
- Highest incidence in 7th decade of life
Clinical Features
- Lymphocytosis, neutropenia, anemia, thrombocytopenia
- Lymphadenopathy, hepatosplenomegaly
- CNS and testes involvement common
- Symptomatic leukostasis and hyperleukocytosis are more common in AML than in ALL, CML, CLL[1]
Differential Diagnosis
Acute Leukemia/Lymphoma
Evaluation
- CXR
- CBC with peripheral smear
- Chem7, Ca, Mg, Phos, Uric Acid, UA, LDH (to check for tumor lysis syndrome)
- LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen (to check for DIC)
- ESR, CRP
- Reticulocyte count in anemia
- Get extra purple top for flow cytometry, especially before transfusion
Management
- Aggressive IV hydration
- If febrile, complete cultures and broad spectrum antibiotics
- Manage Complications
- see DIC
- see Leukostasis
- see Tumor Lysis Syndrome
See Also
- Oncologic emergencies
- Acute leukemia
References
- Porcu P, Cripe LD, Ng EW, et al. Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk.Lymphoma. 2000;39(1-2):1-18.
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