急性白血病Acute leukemia



  • 作者:中山醫 鍾念庭

    簡介

    早期造血細胞不正常增生且無法正常分化

    定義

    blast cell > 20%

    病因

    大多數是未知的,但遺傳和環境因素都有影響,如down syndrome, chemicals, radiation, tobacco, chemotherapy, retroviruses infection

    分類

    抽Bone marrow和周邊血鏡檢,除了細胞學型態外,也利用MPO、nonspecific esterase、chloroacetate esterase、PAS等、或CD染色去區分AML(acute myeloid leukemia)和ALL(acute lymphoblastic leukemia)

    臨床表現

    造成症狀的三個主因

    • 前驅細胞不正常增生但無法成熟分化,造成正常造血細胞數目減少
      fatigue (RBC↓)、bleeding (platelets↓)、infection (neutrophil↓)

    • 器官、組織被白血病細胞浸潤

    • 白血病細胞增生,細胞代謝物增加
      LDH↑, uretic acid↑, K+↑, PO42-↑, Ca2+↓
      (化療治療後更容易發生,稱作Tumor lysis syndrome)

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    References

    • 奇美血液腫瘤科見習筆記
    • Uptodate
      • Overview of acute myeloid leukemia in adults
      • Overview of the outcome of acute lymphoblastic leukemia in children and adolescents
      • Clinical manifestations, pathologic features, and diagnosis of precursor B cell acute lymphoblastic leukemia/lymphoma
      • Clinical manifestations, pathologic features, and diagnosis of precursor T cell acute lymphoblastic -leukemia/lymphoma
    • The Massachusetts general hospital handbook of internal medicine, pocket medicine six edition