USMLE Step 1

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Biochemistry

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Leukemias and Lymphomas

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Acute Myelogenous Leukemia (AML)

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Summary

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Key Points

  • Acute Myelogenous Leukemia (AML)
    • Etiology
      • Caused by malignant transformation of hematopoietic precursors in bone marrow
    • Risk factors 
      • alkylating chemotherapy
      • Radiation
      • myeloproliferative disorders
      • Down syndrome
    • Presentation
      • Classically seen in older adults (median age ~65)
      • Presents with classic leukemic triad
        • Fatigue
          • due to anemia (crowding out of bone marrow inhibits RBC synthesis)
        • Fever/infection
          • due to neutropenia (WBCs synthesized are not functional)
        • Bleeding (ecchymosis, epistaxis, or DIC)
          • due to thrombocytopenia (crowding out of bone marrow inhibits platelet synthesis)
      • Increased circulating myeloblasts on peripheral smear or bone marrow biopsy
        • Diagnosis requires the presence of  ≥20% myeloblasts in the bone marrow
        • These blasts are usually not TDT positive
          • marker for premature LYMPHoid cells (associate with ALL instead)