Aashi
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A 50-year-old man presents with a 3-week history of fatigue, generalized body aches, and a decreased appetite. He states that in the past few weeks he has stopped playing golf three times a week due to dyspnea and fatigue while walking on the course. While brushing his teeth, he has noticed that his gums bleed more easily. He shows you multiple erythematous nodules over his upper extremities. For the past few days, he has been coughing greenish-yellow sputum, and his temperature while at home was 100.9 F. He appears pale and in mild respiratory distress. Vital signs are: temperature 100.7 F, pulse 105/min, and respiratory rate 23/min. You see multiple petechiae on the hard palate. On lung examination, there are rales at the right base with tactile fremitus and egophony. You cannot feel his spleen. You notice multiple erythematous nodules along his arms. Laboratory studies and a peripheral smear show the following:
WBC 80,000/mm3, neutrophils 60%, blasts 8%, lymphocytes 30%, hemoglobin 10 mg/dL, hematocrit 29%, platelets 40,000/mm3. Blasts are present on the peripheral smear.
What is the next best step in the management of this patient?
A) Leukapheresis
(B) Daunorubicin and cytarabine
(C) Platelet transfusion
(D) Bone marrow transplant
(E) All-trans-retinoic acid (ATRA)
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| prathapdoctor
Forum Elite
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AML, Cytarabine and daunorubocin.
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| Guptashutosh
Forum Elite
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This is AML( possibly M3 , with DIC)
1st step CHEMO
then atra / leukopharesis to decrease sludging
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| drashishmahajan
Forum Senior
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with 8% blast .. u cannt label it as AML....
ill say it is CML.....80,000 TLC
T/T--- BMT
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| drashishmahajan
Forum Senior
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| drashishmahajan
Forum Senior
Topics: 6
Posts: 92
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excuse me again ... after going thru thee q again....these is nt evn CML...
i m confused frnds
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| Aashi
Forum Moderator
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Answer:
(B) Daunorubicin and cytarabine
Explanation:
This patient has the signs, symptoms, and hematologic evidence of acute myelogenous leukemia (AML). AML frequently presents with symptoms related to anemia and thrombocytopenia, as seen in this patient's fatigue and easy bleeding. The erythematous nodules seen on the upper extremities are termed Sweet's syndrome and are common in AML. Sweet's syndrome is caused by the cutaneous infiltration of the skin with neutrophils. It may occur even in patients who are profoundly neutropenic.
To make the initial diagnosis of acute leukemia, a peripheral blood smear is all that is usually required. The smear shows blasts, which is characteristic of acute leukemia. The blasts can often tell whether the patient has myelogenous or lymphocytic leukemia. A bone-marrow biopsy confirms the diagnosis when there are 30% or more blasts present. Also seen in the smear or marrow are Auer rods, which are pathognomonic for AML. The white cell count can be elevated, low, or normal. No matter what the count is, the cells are functionally abnormal. In the past, stains for myeloperoxidase and Sudan black helped confirm the diagnosis. This is somewhat antiquated. Flow cytometry is far more accurate.
This patient requires induction chemotherapy with an anthracycline (either daunorubicin or idarubicin) plus cytarabine. Leukapheresis is an emergency treatment for hyperleukocytosis. It is reserved for patients with white cell counts >100,000/mm3 and who have other signs of hyperleukocytosis, such as headache, dyspnea, blurry vision, priapism, and confusion. This patient's dyspnea is from his pneumonia. An allogeneic bone marrow transplant might be appropriate if HLA-matched donors could be found -- but only after the daunorubicin and cytarabine have induced a remission. Autologous transplantations can be done for those without a matched donor.
Remission is defined as the resolution of the presence of blasts on the peripheral smear and <5% blasts in the marrow. All-trans-retinoic acid (ATRA) is a treatment for a specific M3 or promyelocytic type of AML. The ATRA is added to the standard chemotherapy; it is not a substitute.
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| chemamr
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good question 
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| dr.wad
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i have a question....
i want to know what is the class of this AML ?
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