LEUKAEMIA

️Type :

1. ALL

2. AML

3. JMML - juvenile myelomonocytic leukemia (rare)

 

❤What poor prognostic factor leukemia

- Male poorer

- Total White > 50

- Age ; less than 2 year

- Phidalephia chromosome (in JCML)

- Hypodiploid Karyotype (such as in Turner Syndrome) -if hyperploid like Klinefelter/Down Syndrome good prognosis

- More than 10@12 year old

- CNS involvement 

- Splenomegally

- Hepatosplenomegally

- Bone marrow karyotype (percent blast cell)

- Response to first chemotherapy

-Mediastinum mass

 

❤️Significant side effect chemo? - but rate of occurance rare 

 

- Tumor Lysis syndrome

(hyperkalemia, hypocalcemia, hyperphosphatemia, hyperuraemia - lead to Arrythmia / Kidney injury )

 

- Leukoencephalopathy (white matter disease)

- Night blindness

- Reduce hearing  (bleomycin)

- Pulmonary fibrosis

- Cardiac : dilated cardiomyopathy, arrythmia, bradycardia 

- Peripheral Neuropathy 

- GIT : Antropathy

- Renal Toxicity

- Infertility 

 

‼️Urgent Referal 

- SVC obstruction

- Mediastinal mass

- SIADH

- Tumor Compression Effect (spinal compression effect need urgent referal)

- Febrile Neutropenia (late give antibiotic can cause death to patient)

 

🌸Mediastinal widening - leukaemia

SVC obstruction - Lymphoma

 

🌸Prognostic ALL

- Bone Marrow Karyotype

 

🌸Tumor Lysis syndrome mx?

- Hyperhydration

- Do not add pottasium, do not tranfuse  blood cell except indicated, give hyperhyration

 

🌸Drug to prevent urate nephropathy

- Rasburicase / previously allopurinol

 

 

🌸Iron Chelation agent.

Eg : Desferal/ DFP/ Etc

 

Need to give Vit C to increase iron absorbtion. 

 

8. Why patient thallasemia will have hyperpigmented skin?

 

🌸Because hemosiderin deposition in subcutaneous tissue.

 

9. How you monitor iron overload? Any blood parameter we can see?

🌸Serum Feritin level.

 

10. At what level of serum ferritin that we need to give iron chelation agent?

🌸If more than 1000 mcg/L

 

11. How we give desferal, by what route? For how long?

🌸SC/ IV

Eg : DFO : sc infusion 8-12 hours  for 5 nights per week.

 

(Boleh double check Thallasemia Protocol Malaysia)