Acute Myelogenous Leukemia Differential Diagnoses

  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Mar 9, 2012
 
 

Diagnostic Considerations

Failure to rapidly distinguish a patient with acute myelogenous leukemia (AML) from a patient with a less urgent hematologic disorder is the most important medicolegal pitfall in this setting.

Pancytopenia, for example, can be caused by a large variety of diseases of varying severity, including vitamin deficiencies and autoimmune disease. However, pancytopenia due to acute promyelocytic leukemia (APL) is a life-threatening emergency that must be aggressively treated immediately. The easiest way to avoid misdiagnosis is to review the peripheral blood smear at the time of initial evaluation of all patients with hematologic disorders.

Another condition that should be considered in the evaluation of AML is agranulocytosis, a severe subset of neutropenia.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Karen Seiter, MD  Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College

Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology

Disclosure: Novartis Honoraria Speaking and teaching; Novartis Consulting fee Speaking and teaching; Eisai Honoraria Speaking and teaching; Celgene Honoraria Speaking and teaching

Specialty Editor Board

Clarence Sarkodee-Adoo, MD  Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program

Disclosure: Takeda Millenium Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Sacher, MB, BCh, MD, FRCPC  Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians and Surgeons of Canada

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

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Table 1. Immunophenotyping of AML Cells
MarkerLineage
CD13Myeloid
CD33Myeloid
CD34Early precursor
HLA-DRPositive in most AML, negative in APL
CD11bMature monocytes
CD14Monocytes
CD41Platelet glycoprotein IIb/IIIa complex
CD42aPlatelet glycoprotein IX
CD42bPlatelet glycoprotein Ib
CD61Platelet glycoprotein IIIa
Glycophorin AErythroid
TdTUsually indicates acute lymphocytic leukemia, however, may be positive in M0 or M1
CD11cMyeloid
CD117 (c-kit)Myeloid/stem cell
Table 2. Common Cytogenetic Abnormalities in AML
AbnormalityGenes InvolvedMorphologyResponse
t(8;21)(q22;q22)AML/ETOM2Good
inv(16)(p13;q22)CBFb/MYH11M4eoGood
NormalMultipleVariesIntermediate
-7MultipleVariesPoor
-5MultipleVariesPoor
+8MultipleVariesIntermediate-poor
11q23MLLVariesIntermediate-poor
MiscellaneousMultipleVariesIntermediate-poor
Multiple complex*MultipleVariesPoor
* Refers to 3-5 different cytogenetic abnormalities, depending on the classification used.
Table 3. Cytogenetic Abnormalities in APL
TranslocationGenes InvolvedAll-Trans-Retinoic Acid Response
t(15;17)(q21;q11)PML/RARaYes
t(11;17)(q23;q11)PLZF/RARaNo
t(11;17)(q13;q11)NuMA/RARaYes
t(5;17)(q31;q11)NPM/RARaYes
t(17;17)stat5b/RARaUnknown
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