3.leukemia
DESCRIPTION
leukemiaTRANSCRIPT
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LEUKEMIA CATATAN PINGGIR ABS
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GEJALA KLINIS KELAINAN HEMATOLOGI
1. ANEMIA2. PERDARAHAN3. ORGANOMEGALI / TUMOR4. LYMHADENOPATHY
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ANEMIA
PRODUKSI RBC PENGHANCURAN RBC
1.DEFISIENSI
2.JAR.HEMATOPOETIK BERMASALAH
= KURANG / TDK ADA : APLASTIC ANEMIA
= DIDESAK SEL LAIN : MYELOPHTHISIC ANEMIA ( METASTASE DAN LEUKEMIA )
1.POST HEMORRHAGIC ANEMIA
2.HEMOLYTIC ANEMIA
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GEJALA ANEMIA ANEMIA ANEMIA ANEMIA LEUKEMIA ITP DEFISIENSI APLASTIK HEMOLITIK PASKA PERDARAHAN
1. Anemia ++ ++ ++ ++ ++ - -
2.Perdarahan -- ++ -- ++ ++ ++
3.Organomegali -- -- ++ -- ++ - -
4.Lymphadeno -- -- -- -- ++ - -
pathy
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PERDARAHAN
KELAINAN JLH TROMBOSIT BL TIME CL TIME RL
1.Vaskuler N >> N ++
2.Trombosit* @N/<< >> N ++
3. Pembekuan N N >> --
@ N ttp fungsi tdk baik (trombopatia ) * Setiap penyakit yang menyebabkan penurunan trombosit ( ITP,ATP,Leukemia,Aplastik anemia )
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INTRINSIC EXTRINSIC
PROTHROMBIN THROMBIN II. PTT
FIBRINOGEN FIBRIN I. TT
III. aPTT
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LEUKEMIA
PROLIFERASI PATOLOGIS SEL HEMATOPOETIC MUDA ( LYMPHOBLAST / MYELOBLAST )
INV ASI
SUMSUM TULANG
LUAR SUMSUM TULANG
=ANEMIA=THROMBOCYTOPENIA=NEUTROPENIA / LYMPHOCYTOPENIA
=ORGANOMEGALI=CNS=DLL
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LEUKEMIA
AKUT
PENINGKATAN JUMLAH “BLAST”(MYELOBLAST / LYMPHOBLAST ) YANG MONOT0N DI SUMSUM TULANG ( > 5 % )DAN DARAH (> O % )
KRONIK
PENINGKATAN SEL MYELOID / LYMPOID DI SEMUA STADIUM PEMATANGAN DI SUMSUM TULANG DAN DARAH
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LEUKEMIA ALEUKEMIC
GEJALA / TANDA APLASTIC ANEMIA TETAPI ORGANOMEGALI ( + )
PRELEUKEMIC STATE
GEJALA / TANDA APLASTIC ANEMIA TETAPI PADA FOLLOW UP ( 2 – 7 BULAN ) MENUNJUKKAN GEJALA / TANDA LEUKEMIA AKUT
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PENGOBATAN
1. PENUNJANG =Perdarahan =Anemia =Infeksi =Oncologic emergencies
2. SPESIFIK SITOSTATIKA a. Induksi remisi b. Profilaksis SSP Konsolidasi c. Pemeliharaan
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ONCOLOGIC EMERGENCIES
1.SUPERIOR VENA CAVA SYNDROME
2.HYPERLEUKOCYTOSIS WBC > 100.000 /mm3
3.TUMOR LYSIS SYNDROMEHYPERURICEMIA,HYPERKALEMIA DAN HYPERPHOSPHATEMIA URIC ACID NEPHROPATHY
4.ABDOMINAL EMERGENCIES / TYPHLITIS ( NEC DI CECUM )
5.VIRAL INFECTION
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CHRONIC MYELOCYTIC ANEMIA
JUVENILE ADULT
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FEATURE ADULT TYPE JUVENILE TYPE1.Age of max.incidence (year ) 10 – 12 1 – 2
2.Philadelphia chromosome Almost always Never
3.HbF values 2– 7 % 30-70 %
4.Splenomegaly Usually market Mild to moderate
5.Lymphadenopathy with suppuration Occasional Frequent
6.Skin rash None Frequent exzematous rash of face
7.WBC Count at onset Frequently Rarely > 100.000/mm3 >100.000/mm3
8.Thrombocytopenia at onset Uncommon Usually present
9.Blast form in blood Infrequent Often present
10.Megakaryocytes in marrow Often increased Usually decreased
11.Complete remission with th/ Frequent Rare
12.Alkaline phosphatase in neutrophils Decreased Decreased or lower limit of normal
13.Serum B 12 level Increased Increased
14.Maximum nucleated red cells( 105/mm3 ) 0,25-0,5 1-18
15.Monocytes in blood Normal to increased Increased