Lightning Learning: Acute Myeloid Leukaemia
There are 50-60 new cases a year in Leicester, UK – often curable but some will die in the first 24-48 hours of admission. In 2015 there were 3126 cases in the UK alone.
Peak incidence is 85-89 years
Many will initially present through the ED, but not all are critically ill on presentation. Think of acute leukaemia in patients with:
New onset fatigue
Unresolving infection & fever
Unexplained bone pain
Abnormal bruising & bleeding
Patients may present with severe sepsis or DIC – manage as per the Sepsis 6 whilst awaiting haematology doctors.
Bloods: FBC, Blood film, Renal function, Electrolyte, Clotting including Fibrinogen, CRP.
Neutropenic? Isolate the patient
If anaemic then transfuse with caution – giving packed red cells to a patient with a high WCC can cause hyperviscous stroke → Discuss with Haematology.
In frail co-morbid patients, treatment may not be possible and good palliation is key.