Internal Diseases and Therapy · MU Sofia

69. Acute myeloid leukemia

Covers acute myeloid leukaemia as the proliferation of myeloid blasts, its place as the most common acute leukaemia, and the WHO categories. It then explains the marrow failure, neutropenia and thrombocytopenia that follow, the risk factors, and the laboratory workup with its blood smear findings such as Auer rods. It ends with a brief outline of initial supportive care and chemotherapy, with a bone marrow smear image.

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Topic 69 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 1 section, about 318 words (2 min of reading), with 16 flashcards.

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  1. Acute myeloid leukemia

Acute myeloid leukemia

AML is the acute proliferation of myeloid blast cells. AML is the most common of the acute leukaemias, and has a median incidence age of 65 (although risk increases as you get older).

The WHO divides AML into different categories:

  • AML with recurrent genetic abnormalities (cytogenetic abnormalities involving t(8:21), inv(16) and t(15:17)
  • AML with myelodysplastic-related changes (patients with previous myelodysplasia or myeloproliferative disease e.g. CML)
  • Therapy related AML (related to previous chemo)
  • AML not otherwise specified

Characteristically of AML, abnormal blasts are present in the peripheral blood and normal haematopoiesis is reduced, blast %>20% is diagnostic, as are specific clonal cytogenetic abnormalities. The exact aetiology is unknown, however environmental exposure to radiation, benzene and treatment with chemotherapy drugs are all risk factors for developing AML.

In AML the accumulation of blasts in the bone marrow results in its eventual failure, which is the most common cause of death. Neutropenia, common in AML, predisposes to severe infections by endogenous aerobic gram +ve and gram -ve bacteria, these can also be potentially fatal in some cases. Due to the high number of blast cels in the bone marrow, thrombocytes are improperly formed and as such, thrombocytopenia occurs causing bleeding, bruising and petechiae.

Labs should include full FBC, with blood smear, and comprehensive metabolic panel (electrolytes, renal and liver profiles, serum uric acid and LDH) along with coag profile (PT, PTT, fibrinogen and D-dimers). The WBC may exceed 100,000/microliter in 20% of cases, but not all, there is usually accompanying anaemia, neutropenia, and/or thrombocytopenia. The blood smear will show myeloid blasts with auer rods or phi bodies.

Image: “Myeloblast with Auer rod smear 2010-01-27” by Paulo Henrique Orlandi Mourao, CC BY-SA 3.0, via Wikimedia Commons.

In cases of suspected AML first line supportive care is hydroxycarbamide, in acute cases chemotherapy should be started (Cytarabine AND idarubicin OR daunorubicin). If these are unsuccessful, thought should be given to a stem cell transplant.

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