Acute myeloid leukemia (AML) is a malignant myeloid hematopoietic stem/progenitor cell disease. In order to bone marrow and peripheral blood in the original and naive myeloid cell dysplasia as the main characteristics, clinical manifestations for anemia, bleeding, infection and fever, organ infiltration, metabolic abnormalities, etc., the majority of cases are serious, prognosis is dangerous, if not timely treatment often life-threatening. The disease accounts for 30% of childhood leukemia. AML in children is similar to that in adults (<50 years) in terms of molecular biological changes and chemotherapy responses. Infant AML is more likely to develop extramedullary leukemia than adult AML.
The cause of
The exact etiology of leukemia is unknown, but it is associated with regional environmental factors, ionizing radiation, chemical exposure, alcohol and smoking, and specific responses to certain viral infections. In addition, recent studies on gene mutation frequency and some susceptible biomarkers have found that it may be the result of a combination of genetic and environmental factors.
Clinical manifestations of
Anemia in 1.
It is often the first symptom when come on, cadaverous those who appear is early and serious, show progressive aggravation. Anemia presents with positive cytochrome, and sometimes nuclear red cells are seen in the periphery. By anaemia cause clinical expression paleness, lack of power, breath is short of, tinnitus and appetite drop apparently, serious anaemia can bring about anaemic sex heart failure.
2. The bleeding
About 60% of newly diagnosed AML patients have bleeding of varying degrees. Skin mucosa (nose, mouth and gingiva) bleeding is the most common, fundus, bulbous conjunctival bleeding is more common, hematuria is less common, but microscopic hematuria is not easy to be found. Severe gastrointestinal, respiratory and intracranial bleeding is rare but often the cause of death. M3 is often associated with severe bleeding and DIC.
Fever and infection
Often have irregular fever, it may be cancerous fever, but for a long time, for more than 38 ℃ fever often indicate presence of infection, infection can occur in any part of the body, the body.
4. Infiltration of leukemia cells
AML extramedullary infiltration may occur in each subtype of the disease.
(1) M4 and M5 types of skin infiltration are more likely to occur in small infants with high white blood cells, skin infiltration and CNSL. Appearance is macular papule, nodular or mass, color purple, can be multiple and cloth and the whole body or a few scattered in the body surface, and sensitive to radiotherapy.
(2) 25% ~ 50% of M5 and M4 patients with oral gingival changes may have gingival hyperplasia due to leukemia infiltration. In severe cases, gingival swelling is like spongy, with surface rupture and bleeding, but other subtypes of AML gingival hyperplasia are rare. Mucosa, tonsils, or tongue infiltration are less common.
(3) liver, spleen and lymph node enlargement were found in about 40% of the cases (M5 type was more common), and the incidence was lower than ALL. Lymph nodes ranged from big soybean and peanut to pigeon egg size, and were round and plump with no tenderness. They were common in neck, armpit and groin, and lymph node, liver and spleen enlargement were not as obvious as ALL. Giant hepatomegaly and splenomegaly were seen only in small infants with AML.
(4) bone and joint pain AML bone and joint pain are not as common as ALL. Osteoarthralgia tends to occur in the ribs, vertebrae, or long bones of the limbs and large joints such as the elbow and ankle. It is characterized by persistent and paroxysmal increased bone or joint pain or swelling that impedes movement. Children to limbs long bone and joint involvement, often misdiagnosed as rheumatism, rheumatoid arthritis and other diseases. Sternal tenderness is a common sign that contributes to the diagnosis of leukemia.
(5) the incidence of AML at the first diagnosis of central nervous system involvement is unknown, but the total incidence of CNSL at the time of relapse is 5% ~ 20% in children and about 15% in adults, which is significantly lower than ALL. CNSL was mainly infiltrating the pia mater. Clinical occurrence intracranial pressure heighten, cranial nerve is damaged change with cerebrospinal fluid, serious person can change consciously or convulsive, paralytic, produce epileptic appearance to break out even, consciousness obstacle waits.
(6) green tumors with eye symptoms are more common in M1 and M2 types. Bone, periosteum, soft tissue, lymph nodes, or skin are often involved, but orbital and paranasal sinuses are the most common. It may manifest as prolapse of the eyeball, diplopia, or blindness. Retinal and choroidal infiltration of AML is less common than ALL, and may be associated with hemorrhage or blindness. Fundus infiltration often indicates the involvement of CNS.
AML can also occur in the heart, pericardium, lung, pleura, kidney and gastrointestinal and other organs, tissue infiltration, but generally rarely lead to clinical symptoms. Testicular, prostate, ovary, uterine infiltration is rare.
USA
Related case
