Leucemia Caso Clínico

8/3/2019 Leucemia Caso Clnico

1/27

LEUCEMIA: CASO

Francismar Prestes LealMdico HematologistaDocente da UNING

Maring, Paran


2/27

OBJETIVOS Definir leucemia

Classificar leucemia

Entender patognese/fisiopatologia

Listar exames para o diagnstico

Compreender manejo bsico


3/27

Caso Clnico

MFS, mulher de 27 anos, chegou ao PS passandomal, sendo rapidamente cadastrada pelarecepo e atendida pelo mdico de planto

Referiu muito cansao, sonolncia e sangramentos

pelo nariz e pela boca, alm de muitas manchasna pele

Relatou que tudo comeou h poucos dias, mas quepiorou muito hoje

Sentiu tambm, h poucas horas, tremores de frio

Negou qualquer doena prvia, pessoal ou familiar


4/27

Caso Clnico

Exame fsicomostrou:

Prpura

(petquias,hematomas eequimoses)

Epistaxe bilateral Gengivorragia
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5/27

Caso Clnico

O fgado e o bao pareceram levementeaumentados de tamanho

Dados vitais aferidos pela enfermagemrevelaram aumento da FC, da FR e da T,sem alterao da PA

Restante do exame fsico nada mostrou
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6/27

Caso Clnico

Exames complementares foram solicitadosna urgncia, o que foi prontamenteatendido pelo laboratrio

Hemograma foi liberado, aps reviso pormdico hematologista: Hb 7 g/dL, Ht 21% (n/n)

Leuccitos 3.000/mm3

(algumas clulas deaspecto blstico e com bastes de Auer) Plaquetas 30.000/mm3
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7/27

Caso Clnico: SP
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8/27

Caso Clnico

Coagulograma mostrou leveprolongamento dos tempos decoagulao (TAP e TTPa) e queda do

fibrinognio srico

Exame de urina revelou hematria

Demais exames: semparticularidades
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9/27

Caso Clnico

Extenso laminar daaspirao da medulassea esternal (coradacom MGG) mostrou:

Hipercelularidade Predomnio (>70%)

de promielcitoshipergranulares

Bastes de Auer
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10/27

Caso Clnico

Testes Citoqumicosdo mesmo material

mostraram: Peroxidase +++ SBB +++

CAE +++ PAS +
http://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BR


11/27

Caso Clnico

Testes Citoqumicos domesmo materialmostraram:

Peroxidase +++ SBB (Negro do Sudo

B) +++

CAE +++ PAS +
http://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BR


12/27

Caso Clnico

Testes Citoqumicosdo mesmo material

mostraram: Peroxidase +++ SBB +++

CAE (Cloroacetatoesterase) +++ PAS +


13/27

Caso Clnico

Testes Citoqumicos domesmo materialmostraram:

Peroxidase +++ SBB +++ CAE +++

PAS (cido Peridicode Schiff) +


14/27

Caso Clnico

Aps a contagem de500 clulasmedulares (lminacorada com MGG),viu-se que os

promielcitosrepresentavam78% das clulas

nucleadas:

LMA M3


15/27

Caso Clnico

Parte do mesmomaterial foi enviadapara fenotipagem,revelando:

Positividade paraCD11, CD13, CD15 eCD33

Negatividade para

CD10, CD14, CD20 eHLA-DR


16/27

Caso Clnico

Citogentica da

MO revelou:

t(15;17)
http://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BR


17/27

Caso Clnico

Estudos de biologiamolecular

confirmaram:

Mutao genticaPML-RARa (genede fuso)
http://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BR


18/27

Caso Clnico

Diagnstico final:

Leucemia Aguda

Leucemia Aguda Mielide

Leucemia Aguda Promieloctica (M3)

LMA M3, com t(15;17)
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19/27

Caso Clnico
http://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BR


20/27

Caso Clnico


21/27

Caso Clnico


22/27

Caso Clnico


23/27

Caso Clnico


24/27

Caso Clnico


25/27

Caso Clnico

Assim, a equipe desade fechou odiagnstico:

LMA M3, t(15;17)/PML-RARa

Foi iniciado tratamentoadequado e com altacurabilidade
http://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http://www.accentu8dental.com.au/attachments/Image/Oral%2520Diseases/Spontaneous%2520gingival%2520bleeding%2520of%2520same%2520patient%2520with%2520cirrhosis.JPG&imgrefurl=http://www.accentu8dental.com.au/page41.php&usg=__-iZWdzSh1PNwsmMl69x5NcM0b80=&h=264&w=424&sz=28&hl=pt-BR&start=4&tbnid=tLLAefUzwopCcM:&tbnh=78&tbnw=126&prev=/images%3Fq%3Dbleeding%2Boral%2Bleukemia%26gbv%3D2%26hl%3Dpt-BRhttp://images.google.com.br/imgres?imgurl=http:/

Leucemia Caso Clínico

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