USMLE Step 1/2 Review for Med Students!
Brief Tweetorial
5 Leukemias
5 Blood smears
Be able to differentiate them
1. AML
2. ALL
3. CML
4. CLL
5. Adult T-cell leukemia/lymphoma
Brief Tweetorial
5 Leukemias
5 Blood smears
Be able to differentiate them
1. AML
2. ALL
3. CML
4. CLL
5. Adult T-cell leukemia/lymphoma
AML
Typically older patient, although can occur in younger patients.
Abrupt symptoms
Needs urgent Rx
Myeloblasts have Auer rods, but not always
However, if Auer rod seen it has to be AML
APL subtype t(15;17) commonly has Auer rods!
Typically older patient, although can occur in younger patients.
Abrupt symptoms
Needs urgent Rx
Myeloblasts have Auer rods, but not always
However, if Auer rod seen it has to be AML
APL subtype t(15;17) commonly has Auer rods!
ALL
Question will typical have child 1-9, although can occur in older patients.
Mediastinal mass possible usually T-cell (unlike AML)
Abrupt symptoms
Needs urgent Rx
ALL blasts look like AML blats
Would be tricky ? to identify based only on smear
Absolutely no Auer rods
Question will typical have child 1-9, although can occur in older patients.
Mediastinal mass possible usually T-cell (unlike AML)
Abrupt symptoms
Needs urgent Rx
ALL blasts look like AML blats
Would be tricky ? to identify based only on smear
Absolutely no Auer rods
CML
Median age 50
Unusual in children (unlike ALL)
Usually asymptomatic
Splenomegaly
t(9;22)/BCR-ABL->Rx imatinib
Leukocytosis with myeloid cells of all stages of differentiation (myeloblasts, myelocytes, segs) Basophilia
Smear WBC all sizes/shapes (unlike acute leuk)
Median age 50
Unusual in children (unlike ALL)
Usually asymptomatic
Splenomegaly
t(9;22)/BCR-ABL->Rx imatinib
Leukocytosis with myeloid cells of all stages of differentiation (myeloblasts, myelocytes, segs) Basophilia
Smear WBC all sizes/shapes (unlike acute leuk)
CLL
Leukemia of elderly
Never in kids
Usually asymptomatic
? will have old pt with WBC 150,000 (all lymphs) and ask you to treat. Answer is NO!
Smear monotonous cells (unlike CML)
Small lymphocytes (unlike acute luek)
Smudge cells
Can occur with autoimmune hemolytic anemia
Leukemia of elderly
Never in kids
Usually asymptomatic
? will have old pt with WBC 150,000 (all lymphs) and ask you to treat. Answer is NO!
Smear monotonous cells (unlike CML)
Small lymphocytes (unlike acute luek)
Smudge cells
Can occur with autoimmune hemolytic anemia
Adult T-cell leukemia/lymphoma
Rare T-cell leukemia
Patients from Japan, Caribbean(Jamaica and Trinidad) HTLV-1 infection
Wide array of symptoms from asymptomatic to fulminant
What you need to recognize is HTLV-1 association and flowers cells on blood smear.
Will be on test.
Rare T-cell leukemia
Patients from Japan, Caribbean(Jamaica and Trinidad) HTLV-1 infection
Wide array of symptoms from asymptomatic to fulminant
What you need to recognize is HTLV-1 association and flowers cells on blood smear.
Will be on test.
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