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Chapter III D45-D89 Diseases of the blood and
blood-forming organs
นพ.บก เจญล
กมงานลยกรรม รพ.สวรรประชาก นครสวรร
1
Bleeding DisordersBlood Vessel
constriction
Platelet Aggregation
Coagulation Cascade
Blood Vessel Disorders Platelet Disorders Coagulation Disorders
Hereditary
- Telangiectasia
- Marfan syndrome
Function disorder
- Drug: aspirin, clopidogrel
- Renal failure
Hereditary
- Hemophilia
- von Willebrand’s disease
Acquired
- Aging
- Scurvy
- Drug: steroids
- Viral infection
Thrombocytopenia
- Immune: ITP
- Viral infection
- Aplastic anemia
- Chemotherapy
- Blood transfusion
Acquired
- Liver disease
- Drug: heparin
- Immune
- Blood transfusion
Disseminated Intravascular Coagulation: All factor deficiency
2
Bleeding Disorders
Clinical Features Platelet Disorders Coagulation Disorders
Site of beeding Skin
Mucous membranes
Deep in soft tissue (Joints,
Muscles)
Petechiae Present Absent
Ecchymosis (Bruises) Small, superficial Large, deep
Hemarthrosis Extremely rare Common
Bleeding after cuts &
scratches
Yes No
Bleeding after surgery or
trauma
Immediate, usually mild Delayed 1-2 d often severe
3
Thrombocytopenia
Thrombocytosis
Platelet Dysfunction
Platelet Disorders
4
Thrombocytopenia
Decreased Production Increased Destruction Abnormal Distribution
Marrow damage Aplasia
Drugs/Toxins
Hepatitis
Malignancy
Congenital defects Fanconi anemia
TAR syndrome
Rubella
Wiskott-Aldrich syndrome
Autosomal dominants
Ineffective production B12/Folate deficiency
Non-immune DIC
Hemolytic-uremic syndrome
TTP
HELLP syndrome
Immune Drug-induced
Secondary to
SLE
AIDs
Alloimmunization
ITP
Splenomegaly Liver disease
Myelofibrosis
Dilution Multiple blood transfusion
Kasabach-Merrit syndrome
5
5
TTP Schistocytes, Hemolysis (incr. TB/DB, LDH, low
haptoglobin), Thrombocytopenia, Fever, Renal, CNS,
Normal PT & Normal PTT
HUS Schistocytes, Hemolysis (incr. TB/DB, LDH, low
haptoglobin), Thrombocytopenia, Fever, Renal, Normal
PT & Normal PTT but no CNS
DIC Schistocytes, Hemolysis (incr. TB/DB, LDH, low
haptoglobin), Thrombocytopenia, Fever, Renal, &
Bleeding but Elevated PT & PTT
Evans’ syndrome Autimmune Hemolysis (positive Coomb’s test) &
Autoimmune Thrombocytopenia [Others - normal]
ITP Autimmune Thrombocytopenia with no systemic
disease [Others - normal]
Thrombocytopenia
6
Hypersplenism
A disorder which cause the spleen to rapidly and prematurely
destroy blood cells
Spleen will temporarily hold onto up to 90% of the body’s platelets
and 45% of the red blood cells
Splenomegaly
Anemia, Leukopenia and Thrombocytopenia [singly or
combination]
Normocellular or Hypercellular bone marrow
Decreased survival of RBC, Platelet
7
Drug Induced Immunologic Thrombocytopenia
Antibiotics, Hypnotics, Analgesics, Heavy metals, Diuretics,
Chloroquine, Digoxin, Heparin, Tolbutamide
Both the drug and antibody must be present in the system at
the same time for platelets destruction
Thrombocytopenia will occur after 12 hour of drug intake but
the time can still delayed
Thrombocytopenia mostly draws 5–7 day after discontinuation
Megakaryocyte in bone marrow is normal
8
Drug Induced Immunologic Thrombocytopenia
Antibiotics and Antivirals
• Quinine/Quinidine
• Penicillins
• Cephalosporins
• Vancomycin
• Trimethroprim/Sulfa.
• Sulfonamides
• Linezolid
• Valacyclovir
• Ganciclovir
• Indinavir
Cardiovascular medications
• Abciximab
• Tirofibran
• Epitifibatide
• Salicylates
• Digoxin
• Furosemide
Miscellaneous
• Ranitidine, Famotidine
• Valproate
• Interferon
9
Idiopathic Thrombocytopenic Purpura (ITP)
Thrombocytopenia occurs in the absence of any disease
associated with decrease platelet or toxin exposure
Acute ITP
2–6 years; after recovery from viral infection; self limiting
Chronic ITP
mostly 20–40 years women; rare remission
Neonatal ITP
transplacental passage of anti platelet antibody
10
Idiopathic Thrombocytopenic Purpura (ITP)
Thrombocytopenia occurs in the absence of any disease
associated with decrease platelet or toxin exposure
Acute ITP
2–6 years; after recovery from viral infection; self limiting
Chronic ITP
mostly 20–40 years women; rare remission
Neonatal ITP
transplacental passage of anti platelet antibody
11
Thrombocytopenia
Summary Diagnosis ICD-10
Primary thrombocytopenia
Hereditary thrombocytopenia
Fanconi anemia
Wiskott-Aldrich syndrome
Thrombocytopenia with absent radius [TAR]
D69.4
D69.4
D61.0
D82.0
Q87.2
Thrombocytopenia D69.6
Decreased Production
12
Thrombocytopenia
Summary Diagnosis ICD-10
Disseminated intravascular coagulation [DIC]
Thrombotic thrombocytopenic purpura [TTP]
Idiopathic thrombocytopenic purpura [ITP]
Evans’ syndrome
Drugs-induced thrombocytopenia
Thrombocytopenia due to allimmunization
Hemolytic-uremic syndrome [HUS]
D65
M31.1
D69.3
D69.3
D69.5
D69.5
D59.2
Postpartum thrombocytopenia
HELLP syndrome
Transient neonatal thrombocytopenia
O72.3
O14.2
P61.0
Increased Destruction
13
Thrombocytopenia
Summary Diagnosis ICD-10
Hypersplenism
Dilutional thrombocytopenia
Kassabach-Merrit syndrome
D73.1
D69.5
D69.5
Abnormal Distribution
14
Thrombocytosis
Platelet count >500,000 cells/mL
Etiology
• Reactive conditions to infection, inflammation, acute blood
loss, major surgery
• Iron deficiency
• Post splenectomy
• Essential thrombocythemia (ET)
15
Essential Thrombocythemia
A condition that the bone marrow overproduction of platelets,
leading propensity to thrombosis formation and blockage of vessels
Platelet count >600,000 cells/mL
Hematocrit <40% or normal RBC mass
Normal serum ferritin, or normal MCV
No Philadelphia chromosome or bcr/abl gene rearrangement
No cytologic or morphologic evidence of MDS
No cause for reactive thrombocytosis
16
Platelet Dysfunction
Congenital disorders Acquired abnormalities
von Willebrand’s disease
Glanzmann’s thrombasthenia
Bernard-Soulier syndrome
Myeloproliferative disease
Dysproteinemia
Cardiopulmonary bypass
Uremia
Liver disease
Drug inhibition
17
Coagulopathy
Warfarin Adverse effect
Disseminated Intravascular Coagulation
Hemophilia
Coagulation Defect
18
CoagulopathyD68.3 Haemorrhagic disorder due to circulating anticoagulants
Haemorrhage during long-term use of anticoagulants
Hyperheparinaemia
Increase in:
· antithrombin
· anti-VIIIa
· anti-IXa
· anti-Xa
· anti-XIa
Use additional external cause code (Chapter XX), if desired, to
identify any administered anticoagulant
Excludes: long-term use of anticoagulants without
haemorrhage (Z92.1)
D68.4 Acquired coagulation factor deficiency
Deficiency of coagulation factor due to:
· liver disease
· vitamin K deficiency
Excludes: vitamin K deficiency of newborn ( P53 )
D68.5 Primary Thrombophilia-
-
-
-
D68.8 Other specified coagulation defects
D68.9 Coagulation defect, unspecified
D69 Purpura and other haemorrhagic
19
Warfarin Adverse EffectDiagnosis Summary Diagnosis ICD-10
PDx Atrial fibrillation I48
CC Long-term use of warfarin Z92.1
EC
Diagnosis Summary Diagnosis ICD-10
PDx Prolonged PT due to warfarin use D68.4
CC
EC Y44.2
Diagnosis Summary Diagnosis ICD-10
PDx Epistaxis due to warfarin use R04.0
Cb D68.3
Cm Y44.2
น warfarin ตามแพทง
น warfarin ตามแพทง
20
Disseminated Intravascular Coagulation
Prolonged prothrombin time (PT)
Thrombocytopenia
Elevated fibrin degradation product
Fragmented red blood cells
21
Disseminated Intravascular Coagulation
Parameter Result Score
Platelet count (cells/ml)
>100,000 0
50,000-100,000 1
<50,000 2
Elevated fibrin-related markers
e.g. soluble fibrin monomers, fibrin
degradation products
no increase 0
moderate increase 2
strong increase 3
Prolonged prothrombin time
<3 seconds 0
3-5.9 seconds 1
>6 seconds 2
Fibrinogen level>1.0 g/L 0
<1.0 g/L 1
Total score >5 is
compatible with overt DIC
International Society of Thrombosis and Haemostasis
22
Disseminated Intravascular Coagulation
ParameterAcute DIC
(decompensated)
Chronic DIC
(compensated)
Platelet count Reduced Variable
Prothrombin time Prolonged Normal
Partial thromboplastin time Prolonged Normal
Thrombin time Prolonged Normal
Plasma fibrinogen Reduced Normal/Elevated
Plasma factor V Reduced Normal
Plasma factor VIII Reduced Normal
Fibrin degradation products Elevated Elevated
D-dimer Elevated Elevated
23
Disseminated Intravascular Coagulation
Summary Diagnosis ICD-10
Disseminated intravascular coagulation
Neonatal DIC
D65
P60
Abruptio placenta with DIC
Antepartum hemorrhage with DIC
Intrapartum hemorrhage with DIC
Abortion
O45.0
O46.0
O67.0
O08.1
#ระชดของการแง เอใรสเฉพาะ
24
Myelodysplastic Syndrome
Myeloproliferative Neoplasm
Bicytopenia
Pancytopenia
Bone Marrow Disorder
25
Bicytopenia
2 in 3 of Anemia or Neutropenia or Thrombocytopenia
ไรสเฉพาะ แพทไควรสปการจย
Coder องใ 2 รสวมน
D64.9 Anemia
D70 Agranulocytosis [PMN <1,000]
D69.6 Thrombocytopenia
“bi=Two, kyto=cell, penia=poverty”
Ambiguous Diagnosis
26
Pancytopenia
Hemogloglin <13 gm% – male, <12 gm% – female
Total leucocyte count <4,000 cells/mL
Absolute neutrophil count <1,000 cells/mL
Platelet count <100,000mL
“pan=All, kyto=cell, penia=poverty”
27
Pancytopenia“pan=All, kyto=cell, penia=poverty”
Mechanism Congenital Acquired
Decreased Production
Gaucher’s disease
Fanconi’s anemia
Cytotoxic chemotherapy
Radiation therapy
Megaloblastic anemia
Bone marrow infiltration
Myelodysplastic syndrome
Myelofibrosis
Aplastic anemia
Increased DestructionLiver disease
Hypersplenism
Increased Destruction
&
Decreased Production
Autoimmune disease
SLE, RA
Acute viral infections
CMV, EBV, HIV
HIV infections
Tuberculosis
28
Pancytopenia
All of Anemia, Neutropenia and Thrombocytopenia
รสเหมาะสมไแ D61.9 Aplastic anemia, unspecified
หากตรวจพบสาเหแด ในกเนการจย
Hypersplenism
Drug-induced aplastic anemia – phenylbutazone, sulphonamide,
acyclovir, gancyclovir, chloramphenical, phenytoin, carbamazepine, nifedipine
Infections – HIV, Epstein-Barr virus, cytomegalovirus, parvovirus B19
Autoimmune disease – SLE, rheumatoid arthritis
Radiation, Chemotherapy
“pan=All, kyto=cell, penia=poverty”
29
Pancytopenia
Summary Diagnosis ICD-10
Pancytopenia due to
Aplastic anemia
Bone marrow infiltration
Congenital red cell aplasia
Drug-induced aplastic anemia
Radiation-induced aplastic anemia
Idiopathic aplastic anemia
Human immunodeficiency virus disease
Systemic infection
Autoimmune disease
Hypersplenism
!
D61.9
D61.8
D61.0
D61.1 + Y
D61.2 + Y84.2
D61.3
B23.2 + D61.8
D61.8
D61.8
D73.1
Pancytopenia in ICD-10-CM: D61.81
30
Pancytopenia
Summary Diagnosis ICD-10
Pancytopenia due to
Leukoerythroblastic anemia
Myelodysplastic syndrome
Myeloproliferative disease
!
D61.8
D46.-
D47.1
Pancytopenia in ICD-10-CM: D61.81
31
Myelodysplastic Syndrome
กมอาการเดความดปกเซลนำเดในไขกระก ง
งการเจญเบโต การฒนาการ และการำงานของเซล
ำใไขกระกไสามารถสางเดเอดแดง เดเอดขาว และ
เกดเอดไเยงพอ หอเยกา โรคไขกระกเอม
พบในคนอามากกา 60 เอบคงหงไแสดงอาการ
อาจเดจากการไบงและยาเคเยกา Secondary MDS
หอ Drug-induced MDS หอ Radiation-induced MDS
อาจเดจากการสารเคหอสารษ เน ยาาแมลง เบนน
เยกา Toxic-induced MDS
BM does not make enough mature blood cells
32
Myelodysplastic Syndrome
Refractory anemia
Preleukemic anemia
Preleukemia
Refractory anemia with ringed sideroblasts
Refractory normoblastic anemia
Smoldering acute leukemia
Preleukemic syndrome
Subacute myelomonocytic leukemia
Chronic myelomonocytic leukemia
Hypoplastic acute myelogenous leukemia
Refractory anemia with excess myeloblasts
Hematopoietic dysplasia
Dysmyelopotic syndrome
Myelodysplastic syndrome
1938 Rhoades and Barker
1949 Hamilton-Paterson
1953 Blaock et al
1956 Bjorkman
1959 Dacie el al
1969 Dameshek
1973 Saarni and Linman
1974 Sexauer et al
1974 Miescher and Farguet
1975 Beard et al
1976 Dreyfus
1978 Linman and Bagby
1980 Cohen et al
1980 Streuli et al
1982 Bennet et al
BM does not make enough mature blood cells
33
Myelodysplastic SyndromeThe World Health Organization classification 2008
Disease Peripheral blood findings Bone marrow findings
Refractory cytopenia with
unlineage dysplasia (RCUD)
Refractory anemia (RA)
Refractory neutropenia (RN)
Refractory thrombocytopenia (RT)
Uni- or Bicytopenia
<1% blasts
Unileage dysplasia
<5% blasts
<15% ringed sideroblasts
Refractory anemia with ringed
sideroblasts (RARS)
Anemia
no blasts
Erythroid dysplasia
<5% blasts
>15% ringed sideroblasts
Refractory cytopenia with
multilineage dysplasia (RCMD)
Cytopenias (bicytopenia or
pancytopenia)
no or rare blasts
no Auer rods
<10x10
Dysplasia in >2 lineages
<5% blasts
<15% ringed sideroblasts
no Auer rods
34
Myelodysplastic SyndromeThe World Health Organization classification 2008
Disease Peripheral blood findings Bone marrow findings
Refractory anemia with excess
blasts-1 (RAEB-1)
Cytopenias
<5% blasts
no Auer rods
<10x10
Unilineage or multilineage
dysplasia
5-9% blasts
no Auer rods
Refractory anemia with excess
blasts-2 (RAEB-2)
Cytopenias
5-9% blasts
no Auer rods
<10x10
Unilineage or multilineage
dysplasia
10-19% blasts
+ Auer rods
MDS, unclassifiable Cytopenias
<1% blasts
no Auer rods
Unilineage dysplasia in
granulocytes or megakaryocytes
<5% blasts
no Auer rods
MDS associated with isolated
del(5q)
Anemia
<1% blasts
platelets normal or increased
normal to increased megakaryo-
cytic with hypolobated nuclei
<5% blasts
no Auer rods isolated del(5q)
35
Myelodysplastic Syndrome
Summary Diagnosis ICD-10
Myelodysplastic syndrome / MDS D46.9
Refractory anemia / RA
Refractory neutropenia / RN
Refractory thrombocytopenia / RT
Refractory anemia with ring sideroblasts / RARS
Refractory cytopenia with multi-lineage dysplasia / RCMD
Refractory anemia with excess blasts-1 / RAEB-1
Refractory anemia with excess blasts-2 / RAEB-2
MDS, unclassifiable
MDS associated with isolated del(5q)
D46.4
D46.7
D46.7
D46.1
D46.5
D46.2
D46.2
D46.7
D46.6
Refractory anemia with excess blasts in transformation C92.0
The World Health Organization classification
36
Myeloproliferative DiseaseMyeloproliferative neoplasm (MPN), Myeloproliferative disorder (MPD)
กมความดปกเซลนำเดในไขกระกการเมำนวน
เซลเดเอดมากดปก
: Chronic myeloid leukemia (CML), Philadelphia chromosome positive
: Chronic neutrophilic leukemia
: Chronic eosinophilic leukemia / Hypereosinophilic syndrome
: Chronic idiopathic myelofibrosis
: Polycythemia vera
: Essential thrombocythemia
: Myeloproliferative disorder, unclassifiable
37
Myeloproliferative DiseaseMyeloproliferative neoplasm (MPN), Myeloproliferative disorder (MPD)
38
Myeloproliferative Disease
Summary Diagnosis ICD-10
Chronic myeloid leukemia, Philadelphia positive
Chronic neutrophilic leukemia
Chronic eosinophilic leukemia
Chronic idiopathic myelofibrosis
Polycythemia vera
Essential thrombocythemia
Myeloproliferative, unclassifiable
C92.1
D47.1
D47.5
D47.4
D45
D47.3
D47.1
The World Health Organization classification
39
Myeloproliferative DiseaseThe World Health Organization classification
Chronic myelomonocytic leukemia (CMML) Ph-negative, BCR-ABL-negative disorder with monocyte count >1x10
Fewer than 20% blasts plus promonocytes in peripheral blood or bone marrow
Either dysplasia of one or more myeloid lineages or alternative criteria met (acquired
clonal cytogenetic abnormality or monocytosis persisting for at least 3 months and
alternative causes of monocytosis excludes)
Atypical chronic myeloid leukemia (aCML) Ph-negative, BCR-ABL-negative disorder with leucocytosis resulting from an increase in
neutrophils and their precursors, the precursors (promyelocyte to metamyelocytes)
consisting a least 10% of peripheral white cells
Basophils less than 2% of white cells
Monocytes less than 10% of white cells
Hypercellular bone marrow with granulocytic hyperplasia and dysplasia, with or without
dyplasia of other lineages
Fewer than 20% blasts plus promonocytes in peripheral blood or bone marrow
40
Myeloproliferative DiseaseThe World Health Organization classification
Juvenile myelomonocytic leukemia (JMML) Ph-negative, BCR-ABL-negative disorder with monocyte count >1x10
Fewer than 20% blasts plus promonocytes in peripheral blood or bone marrow
Plus two or more of the following
Hemoglobin F increased for age
Immature granulocytes in the peripheral blood
WBC greater than 10x10
Clonal chromosomal abnormality (monosomy 7 not excluded)
GM-CSF hypersensitivity of myeloid precursors in vitro
41
Myeloproliferative DiseaseThe World Health Organization classification
Myelodysplastic/Myeloproliferative disease, unclassifiable One of the myelodysplastic syndromes are meet
There are prominent proliferative features (e.g. platelet greater than 600x10
>13x10
The condition has developed de novo
The criteria for other MDS/MPD (CMML, aCML, and JMML) are not meet
There is no Philadelphia chromosome, BCR-ABL fusion gene, 5q-, inv(3)(q21q26) or
t(3:3)(q21;q26)
42
Myeloproliferative Disease
Summary Diagnosis ICD-10
Chronic myelomonocytic leukemia / CMML
Atypical chronic myeloid leukemia / aCMML
Juvenile myelomonocytic leukemia / JCMML
C93.1
C92.2
C93.3
The World Health Organization classification
43
Leukemia
White Blood Cells
44
Acute Myeloid LeukemiaThe French-American-British (FAB) classification
Category Criteria
M0<3% of blasts MPO or SBB positive
Lymphoid markers negative
Immunological or ultrastructural features of myeloid differentiation
M1
Blasts >90% of bone marrow NEC
>3% of blasts MPO or SBB positive
Maturing monocytic component in bone marrow <10%
Maturing granulocytic component in bone marrow <10%
M2
Blasts 30-89% of bone marrow NEC
Maturing granulocytic component in bone marrow >10% NEC
Maturing monocytic component in bone marrow <20% of NEC or other
criteria of M4 not met
M3 Characteristic morphology
MPO: myeloperoxidase; SBB: Sudan black B; NEC: non-erythroid cells;
45
Acute Myeloid LeukemiaThe French-American-British (FAB) classification
Category Criteria
M4
Blasts >30 of bone marrow NEC
Granulocytic component >20% of bone marrow NEC
Monocytic component >20% of bone marrow NEC and either PB monocytes
>5 x 10
proof of monocytic component
M5aBlasts >30% of bone marrow NEC
Bone marrow monocytic component >80% of bone marrow NEC
Monoblasts >80% of bone marrow monocytic component
M5bBlasts >30% of bone marrow NEC
Bone marrow monocytic component >80% of bone marrow NEC
Monoblasts <80% of bone marrow monocytic component
MPO: myeloperoxidase; SBB: Sudan black B; NEC: non-erythroid cells;
PB: peripheral blood smear
46
Acute Myeloid LeukemiaThe French-American-British (FAB) classification
Category Criteria
M6Erythroid cells >50% of BM cells
Bone marrow blasts >30% of NEC
M7 Blasts shown to be predominantly megakaryoblasts
MPO: myeloperoxidase; SBB: Sudan black B; NEC: non-erythroid cells;
PB: peripheral blood smear
47
Acute Myeloid Leukemia
Summary Diagnosis ICD-10
Acute myeloblastic leukaemia / AML
AML M0
AML M1
AML M2
AML M3
AML M4
AML M5
AML M5a
AML M5b
AML M6
AML M7
C92.0
C92.0
C92.0
C92.0
C92.4
C92.5
C93.0
C93.0
C93.0
C94.0
C94.2
The French-American-British (FAB) classification
48
Acute Myeloid LeukemiaThe World Health Organization classification
Therapy-related AML and myeodysplastic syndrome* Alkylating agent related
Topo-isomerase II inhibitor related
Other types
AML with recurrent genetic abnormalities* AML with t(8;21)(q22;q22)/AML1-ETO fusion
AML with abnormal bone marrow eosinophils and inv(16)(p13q22) or t(16;16)(p13;q22)/
CBFB-MYH11 fusion
Acute promyelocytic leukaemia with t(15;17)(q22;q12)/PML-RARA fusion, and variants
AML with 11q23 rearrangement and MLL abnormality
AML with multilineage dysplasia* Following a myelodysplastic syndrome or a myelodysplasia/myeloproliferative syndrome
Without antecedent myelodysplastic syndrome
*If therapy-related cases have recurrent cytogenetic abnormalities, this is noted
49
Acute Myeloid LeukemiaThe World Health Organization classification
AML, not otherwise categories AML, minimally differentiated (resemble FAB M0)
AML without maturation (resemble FAB M1)
AML with maturation (resemble FAB M2)
Acute myelomonocytic and acute monocytic leukaemia (resemble FAB M5a, M5b)
Acute erythroid leukaemia
Erythroleukemia (resemble FAB M6)
Pure erythroid leukaemia
Acute megakaryoblastic leukaemia (resembles FAB M7)
Acute basophilic leukaemia
Acute panmyelosis with myelofibrosis
Myeloid sarcoma (granulocytic or monocytic)
#Defined as having at least 50% of cells dysplasia in at least 2 lineages
50
Acute Myeloid Leukemia
Summary Diagnosis ICD-10
AML with t(8;21)
AML 1/ETO
AML with eosinophils with inv(16) or t(16;16)
Acute promyeloblastic leukaemia with t(15;17) and variants
AML with 11q23 rearrangement and MLL abnormality
AML with multilineage dysplasia
C92.0
C92.0
C92.5
C92.4
C92.6
C92.8
The World Health Organization classification
51
Acute Myeloid Leukemia
Summary Diagnosis ICD-10
AML, minimal differentiation
AML without maturation
AML with maturation
Acute monoblastic leukaemia
Acute monocytic leukaemia
Erythroleukaemia
Pure erythroid leukaemia
Acute megakaryocytic leukaemia
Acute basophilic leukaemia
Acute panmyelosis with myelofibrosis
Myeloid sarcoma
C92.0
C92.0
C92.0
C93.0
C93.0
C94.0
C94.0
C94.2
C94.7
C94.4
C92.3
The World Health Organization classification
52