hemstoma on extremetiesssssssssssss. pdf.pdf

Hematoma

1. hemstoma on
extremeties
12 y.o
tiredness
easy bruising enlargment of
abdomen
rule in inherited /
Childhod abnormalities
consistent for
liver/splenome
galy ?
Rule in Hematologic
diseases
yes
With
significant lab
thyroid
findings?
WBC indicative
of infection?
no
Rule out Infectious disease
Rule out endocrine related
diseases
bone painlymphadenopathy
Blood culture?
no
Lmyphoproliferative diseases
Myelodypsplastic/proliferative
disease
Ineffective erythropoeisisanemia
MCV LOW
yesyes
Lymphocytosis
RULE OUT
RULE IN T -ALL
Non hodgkin
Hodgkin
PBS/ BPA MATURE
LOOKING SEEN?
NO
RULE OUT
NON/ HODGKIN LMPYHOMAWITH T-CELL
LMYPHOBLAST
CELL
WITH 20< BLAST ?
T- ACUTE LYMPHOBLASTIC LEUKEMIACONFIRM WITH CYTOGENETIC
ANALYSIS
Good prognosis
(1) 2-10 yo
(2) a low white cell count;
(3) hyperdiploid
(4) trisomy of chromosomes 4, 7, and
10; and (5) the presence of a t(12;21)
Poor prognosis
(1) age younger than 2 years, (2)
presentation in adolescence or adulthood;
and
(3) peripheral WBC 100K
(4) Philadelphia chromosome
Multiple myeloma
GELE
ELECTROPHORESIS
CONSISTENT W/ MM
rule out Multiple myeloma
no data
yes
yes
yes
yes
confirm other lab test (ferritin
level, CRP,Lead TIBC, Genetic
analysis
HEMATOLOGIC DISEASESOTHER MYELOPROLIFERATIVE
DISEASES:
Acute Basophilic Leukemia
(ABL)
Acute Monoblastic/Acute
Monocytic Leukemia
(AML-M5)
Chronic Neutrophilic
Leukemia (CNL)
Chronic Eosinophilic
Leukemiac(CEL)
Primary Myelofibrosis
(PMF)
Essential Thrombocytopenia
Mastocytosis
Polycythemia Vera
Erythroleukemia
(Acute Erythroid Leukemia)
REFRACTORY CYTOPENIA
Refractory Cytopenia with
Unilineage Dysplasia
(RCUD)
Refractory Cytopenia with
Multilineage Dysplasia
(RCMD)
2 SYSTEMS OF LEUKEMIA
CLASSIFICATIONS:
WHO CLASSIFICATIONFAB CLASSIFICATION
Based on clinical features,
morphology,
immunophenotype, and
genetic factors
Based on the morphology of
abnormal leukocytes, but
does not consider other
important prognostic
factors.
LEUKEMIA
ACUTECHRONIC
ACUTE MYELOGENOUS
LEUKEMIA
ACUTE LYMPHOCYTIC
LEUKEMIA
CHRONIC MYELOGENOUS
LEUKEMIA
CHRONIC LYMPHOCYTIC
LEUKEMIA
MYELODYSPLASTIC
DISEASES
PATHOLOGY
HEMATOPOIESISLEUKEMOID REACTION
WBC > 25K
INFECTIONDRUGS
TISSUE ISCHEMIAPARANEOPLASTIC
LEUKOCYTE ALKALINE PHOSPHATASE SCOREHigh score: Leukemoid
Reaction
Low score: CMLGrading:
0 No stain
+1 Faint stain
+2 Moderate stain
+3 Strong stain
+4 Strong stain w
cytoplasmic backgroubd
Result: Blue, granular
Normale range: 30-185
PHARMACOLOGY & THERAPEUTICS
Therapeutic Regimen for
Leukemias Acute Myelogenous Leukemia
Chronic Lymphocytic
Leukemia
Acute Lymphocytic Leukemia
in AdultsChronic Myelocytic Leukemia
Acute Lymphoblastic
Leukemia in Children
Chemotherapy
CNS prphylaxis
Stem Cell Transplantation
Targeted Therapy
Chemotherapy
CNS prphylaxis
Stem Cell Transplantation
Targeted Therapy
Targeted Therapy:
Tyrosine Kinase Inhibitors
Chemotherapy
CNS prphylaxis
Stem Cell Transplantation
Targeted Therapy
Targeted Therapy:
FLT3 Inhibitors
(MIDOSTAURIN OR
GILTERITINIB)
IDH INHIBITORS
(IVOSIDENIB OR
ENASIDENIB)
Watchful
Waiting/Observation
Chemotherapy
Immunotherapy
Stem Cell Transplantation
Targeted Therapy
Targeted Therapy:
BTK Inhibotors
(IBRUTINIB AND
ACALABRUTINIB)
PI3K Inhibitors
(IDELALISIB AND
DUVELISIB)
Tyrosine Kinase Inhibitors
Stem Cell Transplantation
Supportive Care
MONOCLONAL
ANTIBODIES: RITUXIMAB,
OBINUTUZUMAB, OR
OFATUMUMAB
Tyrosine Kinase Inhibitors:
IMATINIB
DASATINIB
PONATINIB
PRACTICE OF
CHEMOTHERAPY
Combination ChemotherapyAdjuvant Chemotherapy
Neo-Adjuvant
Chemotherapy
Palliative ChemotherapyResponse Rate and
Remission
Partial Therapeutic
Response
Complete Therapeutic
Response
CELL CYLCE
SPECIFICITY
SPECIFIC DRUGSNONSPECIFIC DRUGS
M PHASES PHASE
VINCRISTINE
VINBLASTINE
PACLITAXEL
DOCETAXEL
METHOTREXATE
CYTARABINE
CISPLASTIN
ALKYLATING AGENTS
ANTIBIOTICS
CISPLASTIN
NITROSOUREAS
Classes of Therapeutic
Drugs
Alkylating DrugsNitrogen Mustard:
BENDAMUSTINE,
CYCLOPHOSPHAMIDE,
IFOSFAMIDE,
MELPHALAN,
CHLORAMBUCIL
NITROSOUREAS:
CARMUSTINE,
LOMUSTINE
PLATINUM ANALOGS:
CARBOPLATIN,
CISPLATIN,
OXALIPLATIN
TRIAZENES-
DACARBAZINE,
PROCARBAZINE,
TEMOZOLAMIDE
ALKYL SULFONATE-
BUSULFAN
ETHYLENEIMINE-
THIOTEPA
ANTIMETABOLITESCYTIDINE ANALOGS –
AZACITIDINE,
DECITABINE,
CYTARABINE,
GEMCITABINE
FOLATE ANTAGONISTS –
METHOTREXATE,
PEMETREXED
PURINE ANALOGS –
CLADRIBINE,
CLOFARABINE,
NELARABINE, 6-
MERCAPTOPURINE,
THIOGUANINE,
FLUDARABINE
PYRIMIDINE ANALOGS
– FLUOROURACIL (5-
FU), CAPECITABINE
(PRODRUG OF 5-FU)
HYDROXYUREA
ANTIMICROTUBULAR
AGENTS
EPOTHILONES
HALICHONDRIN B
TAXANES: PACLITAXEL,
DOCETAXEL,
CABAZITAXEL
VINCA ALKALOIDS:
VINBLASTINE,
VINCRISTINE,
VINORELBINE
TOPOISOMERASE
INHIBITORS
TOPOISOMERASE I
INHIBITORS:
TOPOISOMERASE II
INHIBITORS:
CAMPTOTHECANANAL
OGS:
IRINOTECAN,TOPOTEC
AN
ANTIBIOTICS:
ANTHRACENEDION
E
ANTHRACYCLINES:
DOXORUBICIN,
DAUNORUBICIN,
IDARUBICIN,
EPIRUBICIN
EPIPODOPHYLLOTOXIN
S: ETOPOSIDE AND
TENIPOSIDE
ANTIBIOTICS
ANTHRACENEDION
E
ANTHRACYCLINES:
ACTINOMYCIN D,
DOXORUBICIN,
DAUNORUBICIN
BLEOMYCIN
DACTINOMYCIN
MITHRAMYCIN
MITOMYCIN C
MISCELLANEOUS
TRETINOIN
ARSENIC TRIOXIDE
L-ASPARAGINASE –
CLASS-ENZYME
Targeted Cancer TherapyHormones and Hormone
AntagonistsImmunomodulators
Signal Transduction
InhibitorsMonoclonal Antibodies
Anti-Angiogenesis
Proteasome Inhibitors
MODULE 6
GROUP G
MODULE 6
GROUP G
HEMATOLOGIC SYSTEMHEMATOLOGIC SYSTEM
ALAWI,BAMBAO, CADALIN,CALACA, HARUON, GADOR, MENDIOLA, PUNO,SINAL, TINDAHAN,