• Neoplasms of WBCs that have undergone a malignant transformation
  • Hyperleukocytosis:
    • Occurs with WBC >100,000/mm3
    • Leads to occlusions of small vessels primarily in brain or lungs
    • Present with confusion, stupor, or shortness of breath

Chronic Myelogenous Leukemia
  • Overproduction of granulocytic WBCs (neutrophils)
  • Neutrophil function preserved
  • Thrombocytosis
  • Basophilia
  • Philadelphia chromosome present in bone marrow of >95%

Chronic Lymphocytic Leukemia
  • Most common leukemia in adults
  • Overproduction of monoclonal lymphocytes
  • Cells accumulate in lymph nodes, bone marrow, liver, spleen
  • Particularly prone to herpes virus infections

Acute Leukemias
  • Proliferation of undifferentiated immature cells:
    • Acute myelogenous leukemia (AML) – immature myeloid cells
    • Acute lymphocytic leukemia (ALL) – immature lymphoid cells (blasts)
  • Rapidly fatal


  • Arise from multiple genetic mutations that allow unchecked proliferation and abnormal maturation of cells
  • Familial clustering in chronic lymphocytic leukemia (CLL)
  • Increased incidence of AML, ALL, and chronic myelogenous leukemia (CML) with ionizing radiation

Pediatric Considerations
  • Usually have ALL:
    • Most common pediatric cancer
  • 60–80% remission in those who are standard risk
  • Better overall prognosis, except if <1 yr of age
  • May develop leukostasis at lower levels
  • >30% present with bone or spine pain
  • May have enlarged thymus
  • Allopurinol dose is 3 mg/kg
  • Ceftazidime dose is 50 mg/kg

Pregnancy Considerations
  • 90% of leukemias are AML or ALL
  • Myeloid leukemias are more common
  • CLL is very rare in pregnancy
  • Chemotherapeutics may cause birth defects and/or preterm labor
  • Same prognosis as nonpregnant; do not delay therapy
  • Transfuse earlier than nonpregnant; keep hemoglobin >9.8 mg/dL

Geriatric Considerations
More likely to present with CLL and CML

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