1. AML Clinical Presentation

2. Clinical Presentation: Symptoms Fatigue (50%) Anorexia and weight loss Fever with or without an identifiable infection (10%) Signs of abnormal hemostasis (5%) – Bleeding, easy bruising Petechiae Bone pain Lymphadenopathy Nospecific cough Headache Diaphoresis

3. Physical Findings Fever Splenomegaly Hepatomegaly Lymphadenopathy Sternal tenderness Evidence of infection and hemorrhage Retinal hemorrhages Infiltration of the gingivae, skin, soft tissues, or the meninges with leukemic blasts

4. Hematologic Findings Anemia Reticulocyte count RBC count WBC count Platelet count

5. AML Diagnosis

6. Laboratory Studies CBC with differential count – Presumptive diagnosis Demonstrates anemia and thrombocytopenia Prothrombin time (PT) / activated partial thromboplastin time (aPTT) / fibrinogen / fibrin degradation products measurement – DIC Acute promyelocytic leukemia (APL) - the most common subtype of acute myelogenous leukemia (AML) associated with DIC.

7. Peripheral blood smear – Confirms the findings of the CBC count. – Circulating blasts are usually seen Chemistry profile – LDH, electrolytes, liver function tests, BUN, creatinine, uric acid Perform human leukocyte antigen (HLA) or DNA typing in patients who are potential candidates for allogeneic stem cell transplant

8. Bone marrow aspiration – A blast count can be performed FAB classification: more than 30% blasts in the bone marrow WHO classification: more than 20% blasts in the marrow Bone marrow biopsy – Assess cellularity of the BM – Most important in patients in whom an aspirate can not be obtained  Bone marrow or blood is examined via light microscopy or flow cytometry to differentiate AML from other types of leukemia and to classify the subtype of the disease.  A sample of marrow or blood is also tested for chromosomal translocation by routine cytogenetics or fluorescent in situ hybridization (FISH).  Genetic studies may also be performed to look for specific mutations in genes such as FLT3.