Summary
Definition
History and exam
Key diagnostic factors
- pallor
- ecchymoses or petechiae
Other diagnostic factors
- fatigue
- dizziness
- palpitations
- dyspnea
- infections or fever
- lymphadenopathy
- hepatosplenomegaly
- mucosal bleeding
- skin or testicular mass
- skin infiltration
- gingival enlargement
- bone pain
- abdominal pain
Risk factors
- age over 65 years
- previous treatment with chemotherapy
- previous hematologic disorders
- inherited genetic conditions
- constitutional karyotype abnormalities
- radiation exposure
- benzene exposure
- environmental exposures
- male sex
Diagnostic investigations
1st investigations to order
- CBC with differential
- peripheral blood smear
- coagulation panel
- serum electrolytes and uric acid
- renal function
- LFTs
- serum lactic dehydrogenase
Investigations to consider
- bone marrow aspirate and trephine biopsy
- immunophenotyping (flow cytometry)
- cytogenetic and molecular investigations
- lumbar puncture
- HLA antigen typing
- chest x-ray
- echocardiogram
- multigated acquisition scan
Treatment algorithm
newly diagnosed AML: suitable for standard chemotherapy
newly diagnosed AML: not suitable for standard chemotherapy
newly diagnosed non-high-risk acute promyelocytic leukemia (APML)
newly diagnosed high-risk acute promyelocytic leukemia (APML)
complete remission: AML
complete remission: non-high-risk acute promyelocytic leukemia (APML)
complete remission: high-risk acute promyelocytic leukemia (APML)
relapsed or refractory AML
relapsed or refractory acute promyelocytic leukemia (APML)
Contributors
Authors
Kavita Raj, MD, MRCP, FRCPath, PhD
Consultant Haematologist
Guy's and St Thomas' NHS Trust
London
UK
Disclosures
KR declares that she has no competing interests.
Priyanka Mehta, MD, FRCP, FRCPath
Consultant Haematologist
University Hospital Bristol
Bristol
UK
Disclosures
PM declares that she has no competing interests.
Peer reviewers
Rebecca Connor, MD
Chief Fellow
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
Winston-Salem
NC
Disclosures
RC declares that she has no competing interests.
Roger M. Lyons, MD, FACP
Clinical Professor of Medicine
University of Texas Health Science Center
San Antonio
Cancer Care Network of South Texas
San Antonio
TX
Disclosures
RML declares that he has no competing interests.
Shankaranarayana Paneesha, MD, MRCP, FRCPath
Consultant Haematologist
Department of Haematology and Stem Cell Transplantation
Heartlands Hospital
Birmingham
UK
Disclosures
SP declares that he has no competing interests.
David Marks, MD, MRCP, MRCPath
Professor of Haematology & Stem Cell Transplantation
Department of Molecular and Cellular Medicine
University of Bristol
UK
Disclosures
DM declares that he has no competing interests.
Differentials
- Acute lymphocytic leukemia
- Biphenotypic leukemia
- Myelodysplastic syndrome
More DifferentialsGuidelines
- NCCN guidelines: acute myeloid leukemia
- Clinical practice recommendation on hematopoietic stem cell transplantation for acute myeloid leukemia patients with FLT3-internal tandem duplication
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