Management of acute lymphoblatic leukemia with light on etiology, clinical features, diagnosis and different aspects of management including chemotherapy and radiation therapy
Neuroblastoma diagnosis, treatment, complications, and further management. The main contents of this review have been accessed from MedScape. Please do not reprint or copy this material without permission from the copyright owner.
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
Regarding the Post neonatal resuscitation. Always assess how the resuscitation went - mistakes made and scope for improvement - the Quality Improvement initiatives to improve the Quality of Neonatal Resuscitation - that in turn improves neonatal outcomes.
The neonate required resuscitation must be monitored for potential effects of difficult perinatal transition even though the Neonatal Resuscitation goes successfully. Based on the risk factors and the extent of resuscitation required - the newborn must be monitored. Not every post resuscitation baby needs an NICU monitoring
Post-neonatal resuscitation debriefing and monitoring are crucial aspects of newborn care, aimed at improving outcomes and enhancing team performance in future resuscitations. Debriefing following a resuscitation event allows healthcare teams to discuss the case, assess actions taken, and identify any areas for improvement. This reflective process not only helps in reinforcing correct practices but also in rectifying any gaps in the resuscitation process. It fosters a culture of learning and continuous improvement among neonatologists, pediatricians, and other team members involved.
Post-resuscitation neonatal monitoring is equally vital. After a resuscitation, newborns require close observation to ensure stable organ function and to detect any complications arising from the period of asphyxia or the resuscitation itself. Monitoring includes assessing vital signs, cardiovascular and respiratory function, and neurological status. This vigilant surveillance helps in early detection of issues such as hypoxic-ischemic encephalopathy or other organ dysfunctions, which can be critical in preventing long-term disabilities.
Together, debriefing and monitoring form an integrated approach to post-resuscitation care, ensuring that both the medical team and the newborn receive comprehensive support tailored to enhance recovery and outcomes following critical resuscitation efforts.
Neonatal Resuscitation Programme (NRP) - Preparation for Birth.pptxVannalaRaju2
The Neonatal Resuscitation Program (NRP) is an essential training protocol designed to equip healthcare professionals with the skills necessary to handle emergencies during childbirth, particularly those involving newborns who suffer from birth asphyxia. This guide is meticulously crafted for neonatologists, pediatricians, nurses, and other medical staff involved in the delivery room. The ultimate goal of the NRP is to reduce neonatal mortality rates and improve outcomes for newborns who do not breathe spontaneously or adequately at birth.
Understanding Birth Asphyxia
Birth asphyxia occurs when a newborn fails to establish regular breathing at birth, which can lead to insufficient oxygen reaching the brain and other organs, potentially causing lasting damage or even mortality. Prompt and effective resuscitation could mean the difference between life and long-term disability, or death. The conditions requiring neonatal resuscitation can include physiological challenges, congenital defects, or complications during delivery.
Role of Neonatologists and Pediatricians
Neonatologists and pediatricians are crucial in the NRP process. They are specifically trained to manage and mitigate risks associated with neonatal asphyxia. These specialists use their expertise to quickly assess the newborn's condition and administer life-saving interventions according to NRP guidelines. The guidelines recommend sequences of actions that include initial assessment, airway clearance, and effective ventilation strategies.
NRP Guidelines and Protocols
The NRP guidelines provide a systematic approach starting with the initial steps of warming the newborn to stimulate breathing, clearing the airway, and then providing gentle ventilation if necessary. These steps are critical to stabilize the newborns' condition. If the initial interventions are not successful, advanced resuscitation techniques such as chest compressions and administration of medications may be required.
Training and Certification
The NRP program offers comprehensive training that includes both theoretical knowledge and practical simulations to prepare healthcare providers for real-life scenarios. The training focuses on developing proficiency in decision-making and motor skills required for neonatal resuscitation. Certification in the NRP is often a requirement for healthcare professionals working in maternity wards and birthing centers, emphasizing its importance in clinical settings.
Impact on Neonatal Mortality
Neonatal mortality, particularly those cases related to birth asphyxia, remains a significant global health challenge. The implementation of NRP protocols has been shown to dramatically improve survival rates and health outcomes for affected newborns. Countries that have adopted widespread NRP training and guidelines report lower rates of neonatal mortality and better overall results in the management of complicated deliveries.
Scarlet Fever in Children and its complicationsVannalaRaju2
Scarlet fever is a bacterial illness that arises from a streptococcal infection, specifically the group A Streptococcus bacteria. This infection often follows strep throat, pharyngitis, or tonsillitis. Characterized by a distinct red rash, which feels like sandpaper, scarlet fever commonly affects children. The rash typically starts on the chest and spreads across the body. Accompanying symptoms include a high fever and a sore throat. If untreated, scarlet fever can lead to serious complications such as rheumatic fever. Prompt treatment with antibiotics is crucial to manage the infection and prevent further health issues.
Teething is a natural process: Teething is a normal part of a child's development when their teeth start to emerge through the gums.
Timing varies: The timing of teething can vary from child to child, but it typically starts around 6 months of age and continues until around 2 to 3 years old.
Common symptoms: Common signs of teething include drooling, irritability, gum swelling, chewing on objects, and disrupted sleep.
Soothing techniques: Provide teething rings, chilled (not frozen) toys, or gentle gum massages to help soothe your child's discomfort during teething.
Dental care starts early: As soon as your child's first tooth emerges, it's important to start brushing with a small amount of fluoride toothpaste and schedule their first dental visit by their first birthday.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. INTRODUCTION
• Leukemias are the most common cancers
affecting children.
• Acute lymphoblastic leukemia (ALL) accounts
for 73%, acute myeloid leukemia (AML)
accounts for approximately 18%.
• Chronic myeloid leukemia(CML) is rarely
seen, accounting for less than 4%.
2
3. EPIDEMIOLOGY
• ALL: 3–4 cases per 100,000 white children
• Peak incidence between 2 and 5 years of age
• Accounts for 25–30% of all childhood cancers
• In ALL, boys are more commonly affected than girls
• The incidence of AML is similar for all paediatric age
groups
3
4. INCREASED RISK WITH
• Ionizing radiation
• Chemicals (e.g., benzene in AML)
• Drugs (e.g., use of alkylating agents either alone or
in combination with radiation therapy increases the
risk of AML)
• Trisomy 21 (Down syndrome)
• Bloom syndrome
• Fanconi anemia
4
6. • Acute leukemia is characterized by clonal
expansion of immature hematopoietic or
lymphoid precursors.
• Chronic leukemia refers to conditions
characterized by the expansion of mature
marrow elements
6
Acute Vs Chronic Cellular origin…
7. CLINICAL MANIFESTATIONS
• General Systemic Effects
• 1. Fever (60%).
• Lassitude (50%).
• Pallor (40%).
• Hematologic Effects Arising from Bone Marrow Invasion
• Anaemia – causing pallor, fatigability, tachycardia,
dyspnoea and sometimes congestive heart failure.
• Neutropenia – causing fever, ulceration of buccal
mucosa and infection.
7
8. CLINICAL FEATURES
• 3. Thrombocytopenia – causing petechial, purpura, easy
• bruisability, bleeding from mucous membrane and
sometimes internal bleeding (e.g., intracranial
haemorrhage).
• Clinical Manifestations Arising from Lymphoid
System Infiltration
• Lymphadenopathy
• Splenomegaly.
• Hepatomegaly.
8
9. CLINICAL FEATURES
• Clinical Manifestations of Extramedullary Invasion
• CNS‐ ICT symptoms, seizures
• Genitourinary‐painless testicular swelling
• Bone joints‐ bone pain
• Skin‐bleeds
• Git‐ bleeds
9
11. Cytologic
Features
L1 L2 L3
Cell size Small cells
predominate
Large, heterogeneous in
size
Large and
heterogeneous
Nuclear chromatin Homogeneous Variable, heterogeneous Finely stippled and
homogeneous
Nuclear shape Regular, occasional clefting
or indentation
Irregular, clefting and
indentation common
Regular, oval to round
Nucleoli Not visible, or small and
inconspicuous
One or more present, often
large
Prominent, one or more
vesicular
Amount of
cytoplasm
Scanty Variable, often
moderately abundant
Moderately
abundant
Basophilia of
cytoplasm
Slight or moderate, rarely
intense
Variable, deep in some Very deep
Cytoplasmic
vacuolation
Variable Variable
11
Often prominent
12. FAB types of acute lymphoblastic leukemia (ALL). (A)
L1 morphology with uniform‐sized blasts. (B) L2 ALL with
more blast cell variation. (C) L3 blasts with more clumped nuclear chromatin,
nucleoli, basophilic cytoplasm, and cytoplasmic vacuoles.
12
13. Myleoperoxidase and esterase can be
positive in AML.
Generally, when morphologic
classification is difficult,
these histochemical tests are of little
help
CYTOCHEMISTRY
13
14. IMMUNOPHENOTYPING
• B‐ALLs are arrested at various stages of pre‐B
cell development. The lymphoblasts usually
express the pan B‐cell marker CD19 as well
as CD10.
• Similarly, T‐ALLs are arrested at various stages of
pre‐T cell development. In most cases the cells
are positive for CD2, CD5, and CD7.
14
16. INVESTIGATION AND TREATMENT
• Blood count
• Haemoglobin: Moderate to marked reduction
• White blood cell count: Low, normal, or
increased
• Thrombocytopenia: 92% of patients have
platelet counts below normal
• Blood smear: Blasts are present on blood
smear. Very few to none in patients with
leukopenia.
16
17. BONE MARROW
Leukemia must be suspected when the bone
marrow -
• contains more than 5% blasts.
• The hallmark of the diagnosis of acute leukemia
is the blast cell, are relatively undifferentiated
cell with diffusely distributed nuclear
chromatin, one or more nucleoli and basophilic
cytoplasm.
17
19. INVESTIGATIONS
• Chest radiograph: Mediastinal mass in T‐cell leukemia.
• Blood chemistry: Electrolytes, blood urea, uric acid,
liver function tests, Immuno globulin levels.
• Cerebrospinal fluid: Chemistry and cells. Cerebrospinal
fluid findings for the diagnosis of CNS leukemia require:
Presence of more than 5 WBCs/mm3
19
20. CNS LEUKEMIA
• CNS involvement in leukemia is classified as follows:
• CNS1 ,5 WBCs/mm3, no blasts on cytocentrifuge slide
• CNS2 ,5 WBCs/mm3, blasts on cytocentrifuge slide
• CNS3 >5 WBCs/mm3, blasts on cytocentrifuge slide
20
21. INVESTIGATION
Coagulation profile: Decreased coagulation
factors that
•frequently occur with AML are:
hypofibrinogenemia, factors V, IX and X.
21
22. TREATMENT
• In general, treatment regimens for children with newly
diagnosed ALL include three phases: remission induction,
consolidation (or intensification), and continuation (or
maintenance).
• Protocol adopted depends on the institution
• Modified BFM or COG protocol is often the choice
22
25. MAINTENANCE
• Inj. VCR 1.5 mg/m2 one in a month
• Tab PREDNISOLONE 60 mg/m2 for one wk
• T.6MP 50 mg/m2 p.o daily
• T.MTX 20 mg/m2 p.o wkly
• The optimal duration of therapy remains unknown.
Most investigators continue to treat patients for 2 to 3
years, based on results of older studies
25
26. SUPPORTIVE CARE
• A total of 10 mg/kg/day of allopurinol in divided doses is
given in all cases before the commencement of
antileukemic drugs.
• When the blast cell count is more than 50,000/mm3 or there
are large tumor masses, allopurinol is obligatory, together
with a fluid intake of 2–3 L/m2/day
26
27. SUPPORTIVE TREATMENT
• Supportive care including the use of packed red cells
• When high fever and possible septicemia occur in the presence
of neutropenia, antibiotic therapy should be started after
taking appropriate blood cultures and a chest
radiograph.(NEUTROPENIA REGIME)
• Platelet transfusions should be administered to patients with
overt bleeding or when the platelet count is below 10,000/mm3.
27
28. REMISSION
• Minimal Residual Disease and its Implication in the
Management of Leukemia
• MRD detection are now used as prognostic markers after
induction.
• Patients with >0.01% leukemic cells after the end of
induction have a worse prognosis and may require more
intensive therapy.
28
29. RISK STRATIFICATION
Factor Favourable Intermediate Unfavourable
Age (years) 1–9 >/=10 <1 and MLL1
White blood cell count
10 9/L
<50 >50
Immunophenotype Precursor B cell T cell
Genetics Hyperdiploidy .50
chromosomes orDNA
inde
x .1.16 ,Trisomies
4,10 and 17 ,
t(12;21)/ETV6‐ CBFA2
Diploid,t(1;19)
/TCF3‐PBX
t(9;22)/BCR‐ ABL1,
t(4:11)/MLL‐AF4,
Hypodiploid ,44
chromosomes
CNS status CNS1 CNS2 CNS3
MRD (end of
induction)
<0.01% 0.01% to
0.99%
>or=1%
30. D/D
• ITP‐
ITP is the most common cause of the acute onset of petechial and purpura
in children. Patients with ITP usually present with isolated
thrombocytopenia, well child with no lymph node enlargement or
spenomegaly usually
• Aplastic Anaemia
Pancytopenia with no organ enlargement
• Juvenile Rheumatoid Arthritis
30
31. • Infectious Mononucleosis
The atypical lymphocytes observed with acute Epstein‐Barr virus (EBV)
and other viral infections can sometimes be confused with peripheral
leukemic blasts because they are larger than normal lymphocytes.
• Metastatic Solid Tumors
Children with neuroblastoma frequently have malignant involvement
of liver, lymph nodes, bone, or bone marrow; the marrow
involvement may be extensive
31
32. RELAPSE
• Bone Marrow Relapse in Children with ALL
• Despite current intensive front‐line treatments, 20% of
children with ALL experience bone marrow relapse.
• Relapse may be an isolated event in the bone marrow or
may be combined with relapse in other sites
32
33. RELAPSE
• Isolated Extramedullary Relapses
Isolated extramedullary relapses, occurring either
in the CNS or testis, are less frequent than
marrow relapses in ALL.
• Such relapse may not actually be isolated
33
34. • AML
• Number of risk factors have been identified,
including ionizing radiation, chemotherapeutic
agents (e.g., alkylating agents,), organic solvents,
paroxysmal nocturnal hemoglobinuria
• Down syndrome, Fanconi anaemia, Bloom
syndrome, Kostmann syndrome,
Shwachman‐Diamond syndrome,
Diamond‐Blackfan syndrome, Li‐Fraumeni
syndrome, and neurofibromatosis type 1.
34
35. DEFINITION
• The World Health Organization (WHO) classification of
AML defines that 20% blasts are required for the
diagnosis of AML
35
37. CLINICAL FEATURES
• Anaemia, thrombocytopenia ,leucopenia
• Subcutaneous nodules or “blueberry muffin” lesions (especially in
infants), infiltration of the gingiva (especially in M4 and M5 subtypes)
• Signs and laboratory findings of disseminated intravascular
coagulation (especially indicative of acute promyelocytic leukemia
• Discrete masses, known as chloromas or granulocytic sarcomas, typically
are associated with the M2 subcategory of AML with a t(8;21)
translocation.
37
38. (A)Minimally differentiated acute myeloid leukemia
(FAB M0). (B) Acute myeloid leukemia without maturation (FAB M1). (C) Acute myeloid
leukemia with maturation (FAB M2). There are at least 10% of cells showing maturation.
(Inset) The blasts are myeloperoxidase‐positive by cytochemistry
38
39. DIAGNOSIS & TREATMENT
• Bone marrow aspiration and biopsy specimens of
patients with AML typically reveals the features of a
hypercellular marrow consisting of a monotonous
pattern of cells with features that permit FAB
subclassification of disease.
• Flow cytometry and special stains assist in identifying
myeloperoxidase‐containing cells
39
40. TREATMENT
AML‐protocol (Modified from MRC 12)
• Daunorubicin 50 mg/m2 IV days 1, 3, 5
• Cytosine arabinoside 100 mg/m2 IV bolus every 12 hours
days 1 to 10 (20 doses)
• Etoposide 100 mg/m2 IV 1 hour infusion days 1 to 5
• Intrathecal cytarabine age adjusted doses at time of
diagnostic LP
40
41. TREATMENT
• Acute promyelocytic leukemia (FAB‐M3), characterized
by a gene rearrangement involving the retinoic acid
receptor [t(15;17); PML‐RARA], is very responsive to
all‐trans‐retinoic acid (tretinoin) combined with
anthracyclines and cytarabine.
• The success of this therapy makes marrow
transplantation in first remission unnecessary for
patients with this disease
41
42. JMML
• JMML is a rare, clonal, myeloproliferative disorder of the
stem cell that usually manifests in the first few years of life.
• It has also been referred to as juvenile chronic
myelomonocytic leukemia (JCML), infantile monosomy 7
syndrome, or juvenile granulocytic leukemia
42
43. CLINICAL FEATURES
• The most common symptoms are fever, cough,
infection, pallor, malaise, hepatosplenomegaly,
lymphadenopathy, rash, bleeding, and failure to
thrive.
43
44. • Several treatment regimens have been used to
improve survival, including low‐dose
chemotherapy, intensive AML‐ type therapy, and
13‐cis‐retinoic acid.
• The only known curative therapy for JMML is
allogeneic HSCT, and neither pre‐treatment
chemotherapy nor splenectomy has not
been found to impact survival.
44