Acute Lymphoblastic Leukemia Pathophysiology Diagram

Acute Lymphoblastic Leukemia Pathophysiology Predisposing Factors: Age Gender Race Family HIstory

Precipitating Factors:  exposure to radiation and certain chemicals  having a sibling with leukemia  HTLV-1 virus  genetic abnormalities  chromosomal translocations

ETIOLOGY: Unknown

U mutations in Somatic the DNA

Activate oncogene/ deactivate tumorsupppresor gene

Malignant transformation of lymphoid stem cells

Uncontrolled proliferation of lymphoblast in the bone marrow Diagnostic Test: BM aspiration BM biopsy

Lymphoblast replace the normal marrow elements

Decreased production of normal blood cells

s/sx: bone pain joint pain

Treatment:  Remission Induction Therapy  Consolidation and Maintenance Therapy  BM Transplantation  CNS prophylaxis

Treatment: Analgesic

Diagnostic Test: CBC

s/sx: fever, chills seizure

Leukopenia 9

(↓4.36 x 10 /L)

Infection

Decreased production of normal blood cells

Spillage of lymphoblast into the bloodstream

s/sx:  presence of petechiae  bruise & bleed easily  anemia  fatigue  dizziness  palpitations  dyspnea

Treatment:  Blood transfusion  Epoetin and hemapoetic stimulants

Organ infiltration If treated: Antibiotic Ig Leukapheresis

If not treated

Septicemia

Prevention of complications

Kidneys

Renal failure

s/sx:  Little/ no UO  ↑RR  Flank pain  Restless  n/v  legs and feet swelling  uremia  azotemia

Death

Diagnostic Test: MRI Treatment: Intrathecal chemotherapy

Diagnostic Test: Spinal Tap

CNS

leukocyte cells impairs the circulation of CSF

leukocyte cells compresses spinal/ cranial nerves

Progress to coma

s/sx: h/a, weakness, blurred vision, balance difficulty, vomiting, lethargy

s/sx: ↑ CSF leukocytes s/sx: cranial nerve palsies confusional states optic neuropathy cerebellar dysfunction papilledema

Liver / Spleen

Extra cells cause the liver/spleen to rupture

bleeding

Hypovolemic shock

Diagnostic Test: Ultrasonography

s/sx: hepatomegal y splenomegaly elevated ALT (81 u/L) s/sx: hypotension tachypnea tachychardia

Overgrown thymus

Compress the Superior Vena Cava

s/sx: shortness of breath cough suffocation

Physical Exam Diagnostic test: Lymph node biopsy

s/sx: lymphadenopathy SVC syndrome

s/sx:  swelling of head, neck and arms  obstruction of blood flow

Treatment:  O2 administration  Bronchodilators

s/sx: cough, wheezes, respiratory tract obstruction

s/sx: dysphagia

s/sx: hemoptysis

DEATH

Lymph nodes

Mediastinal lymphadenopathy

Bronchial/tracheal obstruction Esophageal compression

Erosion of node into a bronchus/ trachea

Severe hypoxia