Acute leukemia

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Acute leukemia

Hematological system

Hematological system

Hematological system

Hematological system


Acute leukemia


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USMLE® Step 1 questions

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High Yield Notes

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Acute leukemia

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USMLE® Step 1 style questions USMLE

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 40-year-old woman is brought to the emergency department because of recurrent epistaxis and ongoing gingival bleeding. She has no history of trauma. Past medical history is noncontributory. Family history is significant for hemophilia A in her brother. Temperature is 37.0°C (98.6°F), pulse is 125/min, respirations are 20/min, and blood pressure is 105/75 mmHg. Physical examination shows mucosal pallor and petechiae on the lower extremities. There is ongoing oozing of blood from the gingiva. Laboratory studies are shown:  
 Laboratory value  Result 
 Complete blood count 
 Hemoglobin   8.6 g/dL 
 Platelets   60,000/mm3 
 Leukocytes   3,500/mm3 
 Coagulation profile 
 Prothrombin time (PT)  25 sec 
 Activated partial thromboplastin time (aPTT)  50 sec 
 Bleeding time (BT)   11 minutes 
 Plasma fibrinogen  150 mg/dL   (N = 200-400 mg/dL) 
 D-dimer   1200 ng/dL   (N = <500 ng/mL) 

After stabilization and appropriate workup, bone marrow biopsy is performed and is shown below:

Retrieved from: Wikimedia Commons  

Chromosomal analysis of the abnormal cells will most likely show which of the following abnormalities?   

External References

First Aid








Acute lymphoblastic leukemia (ALL) p. 440

associations with p. 730

methotrexate for p. 446

oncogenes and p. 222

Tumor markers

acute lymphoblastic leukemia p. 440


With acute leukemia, leuk- refers to white blood cells, and -emia refers to the blood, so in acute leukemia, there’s uncontrolled proliferation of partially developed white blood cells, also called blast cells, which build up in the blood over a short period of time.

Although leukemia means cancer white blood cells, it can also be used to refer to cancer of any of the blood cells, including red blood cells and platelets.

Acute leukemia can be broadly classified into acute myeloid leukemia, or AML; and acute lymphoblastic leukemia, ALL.

AML is more common in old age, where as ALL is more common in children. In both cases, accumulation of blast cells interferes with the development and function of healthy white blood cells, platelets, and red blood cells.

Now, every blood cell starts its life in the bone marrow as a hematopoietic stem cell. Hematopoietic stem cells are multipotent -- meaning that they can give rise to both myeloblasts, which are precursors of myeloid blood cells, and lymphoblasts, which are precursors of lymphoid blood cells.

These lymphoblasts can be pre-B cells, which develop into B lymphocytes; or pre-T cells, which develop into T lymphocytes.

If a hematopoietic stem cell develops into a myeloid cell, it’ll mature into an erythrocyte -- or a red blood cell, a thrombocyte -- or a platelet, or a leukocyte -- or a white blood cell, like a monocyte or granulocyte.

Granulocytes are cells with tiny granules inside of them -- they include neutrophils, basophils, and eosinophils.

If a hematopoietic stem cell develops into a lymphoid cell, on the other hand, it’ll mature into some other kind of leukocyte: a T cell, a B cell, or a natural killer cell, which are referred to as lymphocytes.


  1. "How I treat mixed-phenotype acute leukemia" Blood (2015)
  2. "Acute Erythroid Leukemia" Archives of Pathology & Laboratory Medicine (2010)
  3. "Acute Myeloid Leukemia" New England Journal of Medicine (2015)
  4. "Adult T-Cell Leukemia: Clinical and Hematologic Features of 16 Cases" Blood (1977)
  5. "The discovery of ATL: an odyssey in restrospect" International Journal of Hematology (2011)

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