Hemato-Oncology -11-Acute Leukemia

HEMATO-ONCOLOGY PART-11

Welcome to the eleventh part of a series on Hemato-oncology i.e. cancers of the hematopoietic system. In last 10 parts, we mostly discussed role of Stem Cell Transplant/Bone Marrow Transplant – both Autologus and Allogeneic, for both benign and malignant blood disorders.

Question: Dr. Chiragbhai, thank you for all the insight into Transplant. Now it is time to talk about individual “cancers of blood”. By the way, what are you doing in Rome?
Answer: Well, I did enjoy talking to you about Transplant, and by now we have completed 26transplants, including one for myelodysplastic syndrome with very good results. And yes, I am in Rome, Italy now. I am working with Prof. Guido Lucarelli. He has done over 1000 (yes, over one thousand!), maximum in world, transplants only for Thalassemia major, and with Best results in world too. He has now started transplanting patients who do not have a sibling donor, with new techniques.

Que: So, Chiragbhai, what do we talk about first?
Ans: Acute Myeloid Leukemia – AML.
This is the diagnosis that scares all patients and most doctors too. This is a disease which requires a lot of effort, resources and care from whole treating team, almost like a transplant. It is a classic example of a hematological malignancy which can be rapidly fatal if not diagnosed and managed quickly and properly.

Patients may or may not seem very sick. Presentation can be very benign, e.g. on a routine blood test or with mild fatigue. Very difficult for patient to accept. I recently counseled such a patient before coming to Rome, who repeated tests at three places and yet is not ready to accept diagnosis, with counts steadily worsening over few days.
At presentation, White blood cell count may be normal, high or even low. Platelets are generally low, but can be normal, as in this case I counseled. Hb is variable, but generally low. Such patients who are looking very “stable” are like a “Time Bomb”, they can collapse any time, from hemorrhage or major sepsis, and should be under strict monitoring, preferably hospitalized (especially if their platelet count is less than 50,000 or wbc over
30,000).

Frequently cbc machine gives wrong high platelet count in AML, and so pts and drs are comfortable. I have had three patients who died like this, even before seeing me. All these were from senior physicians who felt that since patient was “stable”, they will send him on Monday to opd, not over weekend. By Monday, they had died, most likely from intracranial hemorrhage.
AML should be respected like “HEART ATTACK”. Whenever it is suspected, a Hematologist must be involved right away. I tell patient that this is a

“BLOODATTACK ”.

Second, more common presentation is a more sick patient, with mostly fever, marked weakness, and some bleeding manifestations like petechiae/ecchymoses/gum bleed, and very high wbc or very low platelets. These are obvious emergencies and should be referred immediately like a “

“BLOODATTACK ”.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad. drchiragashah@gmail.com
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad.
www.shyamhemoncclinic.com