Examqo › Examqo library › Internal medicine › Haematology · IMLE
Leukaemias in adults: AML, ALL, CML and CLL
Acute leukaemia presents with marrow failure and blasts (20% or more in the marrow); suspected APL — bleeding with DIC — needs ATRA at once, even before genetic confirmation; and early asymptomatic CLL is only watched.
Why it matters in the exam
The typical question presents an adult with weakness, infections and bleeding, with cytopenia or leukocytosis and blasts on the film. Auer rods point to AML. The most-tested emergency is acute promyelocytic leukaemia (APL, t(15;17)): severe bleeding and DIC — treatment is ATRA at once (with arsenic trioxide), because any delay raises death from bleeding. Other emergencies: tumour lysis syndrome (hyperkalaemia, hyperphosphataemia, hypocalcaemia, high uric acid and AKI) — fluids and allopurinol, with rasburicase at high risk (contraindicated in G6PD deficiency); and leukostasis when white cells are above 100,000 — hydroxyurea and sometimes leukapheresis.
The chronic leukaemias are tested in fixed patterns: CML — leukocytosis with all stages of maturation, basophilia and a large spleen, with the Philadelphia chromosome t(9;22) (BCR-ABL), treated with a tyrosine kinase inhibitor (imatinib); CLL — an older adult with lymphocytosis (above 5000 clonal lymphocytes), "smudge cells" on the film and enlarged nodes, treated only when there are symptoms, cytopenias or advanced disease; CLL is also linked to autoimmune haemolytic anaemia and antibody deficiency. In AML in a fit patient: "7+3" induction (cytarabine and an anthracycline); in an unfit older patient — venetoclax with azacitidine.
Key points
- Acute leukaemia: 20% blasts or more; Auer rods point to AML.
- APL: bleeding and DIC — ATRA at once.
- Tumour lysis syndrome: fluids, allopurinol, rasburicase at high risk.
- CML: t(9;22), BCR-ABL — imatinib.
- CLL: lymphocytosis above 5000, smudge cells; observe early disease.
Summary table
| Disease | Clue | Diagnosis | Treatment |
|---|---|---|---|
| AML | Cytopenia, blasts, Auer rods | 20% blasts or more in marrow, genetics | "7+3" if fit; venetoclax + azacitidine if unfit |
| APL | Bleeding, DIC | t(15;17), PML-RARA | ATRA at once + arsenic trioxide |
| ALL | More in children, but adults too; nodes, CNS involvement | Lymphoblasts 20% or more | Chemotherapy; Philadelphia → TKI |
| CML | Leukocytosis with all maturation stages, basophilia, large spleen | t(9;22), BCR-ABL | Imatinib (TKI) |
| CLL | Older adult, lymphocytosis, smudge cells | Above 5000 clonal lymphocytes, flow cytometry | Observe early disease; treat symptoms |
| Tumour lysis syndrome | High potassium, phosphate and uric acid; low calcium | After treatment starts | Fluids, allopurinol; rasburicase at high risk |
A free exam question
בן 66, עם יתר לחץ דם, שעבר לפני כ- 3 ,חודשים אבלציה לצורך טיפול בפרפור עליות התקפי מתלונן על קוצר נשימה והמופטיזיס שמוחמרים מאז הפרוצד ורה. מה האבחנה הסבירה ביותר שתביא להסתמנות זו? (the question as examined, in Hebrew)
- א. Esophageal tear
- ב. Pulmonary embolism
- ג. Pulmonary valve stenosis
- ד. Mitral valve stenosis
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Medical licensing exam (IMLE), Internal medicine, Oncology.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- European LeukemiaNet (ELN) recommendations for diagnosis and management of AML in adults, 2022 — Diagnosis, risk and treatment
- Harrison's Principles of Internal Medicine, 21st edition (2022) — Acute Myeloid Leukemia; Chronic Myeloid Leukemia; Chronic Lymphoid Leukemias
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.