20. Other Haematological Malignancies Flashcards
What is Purpura and what is the cause
appearance of a non-blanching red spots on the skin that are caused by small areas of bleeding under the skin
Purpura are less than 1cm, but larger bleeding is referred to as what
ecchymoses
Why is it more clinically significant with a younger patient presents with Purpura, compared to older
older people often have no underlying pathology and is usually due to increased skin fragility and weaker blood vessels
in a younger subject sudden onset of gum bleeding/purpura, ecchymoses should raise the possibility of what kind of things
TTP- thrombotic thrombocytopenic purpura
HUS- haemolytic uraemic syndrome
Infections; such as meningococcal sepsis
Haematological malignancies: such as leukaemia
What autoimmune conditions should be suspected in someone who presents with purapura an urinary manifestations such as haematuria or oliguria
TTP and HUS
What is leukaemia
- the name for the cancer of a particular line of the stem cells in the bone marrow
- causes unregulated production of certain types of blood cells
- can be classified depending on how rapidly they progress and the cell line that is affected
what is the main 4 classifications of leukaemia
- Acute myeloid leukaemia
- Acute lymphoblastic leukaemia
- Chronic myeloid leukaemia
- Chronic lymphocytic leukaemia
note there are other ones
What is the big issue in leukaemia in terms of production of other cells
excessive production of an abnormal cell can lead to suppression of the other cell lines causing underproduction of other cells
this results inn pancytopenia
what is pancytopenia
combination of low red blood cells (anaemia), white blood cells (leukopenia) and platelets (thrombocytopenia)
What is the mnemonic to remember the progressive ages of the different leukaemias in steps of 10 years from 45-75 (note that the first one also is most common in under 5s)
ALL CeLLmates have CoMmon AMbitions
- Under 5 and over 45 – acute lymphoblastic leukaemia (ALL)
- Over 55 – chronic lymphocytic leukaemia (CeLLmates)
- Over 65 – chronic myeloid leukaemia (CoMmon)
- Over 75 – acute myeloid leukaemia (AMbitions)
What is the usually presentation of leukaemia
quite non-specific
- Fatigue
- Fever
- Failure to thrive (children)
- Pallor due to anaemia
- Petechiae and abnormal bruising due to thrombocytopenia
- Abnormal bleeding
- Lymphadenopathy
- Hepatosplenomegaly
is bleeding under the skin leading to bruising and petechiae is a common presenting feature of leukaemia. but what other differentials would you be thinking of
- Leukaemia
- Meningococcal septicaemia
- Vasculitis
- Henoch-Schonlein Purpura (HSP)
- Idiopathic Thrombocytopenia Purpura (ITP)
- Non-accidental injury ie abuse
What investigations would you order if you suspect someone has leukaemia
FBC
Blood film
lactate dehydrogenase (LDH)
bone marrow biopsy
ETC
which of the main leukaemia is the most common children and associated with downs syndrome • Acute myeloid leukaemia • Acute lymphoblastic leukaemia • Chronic myeloid leukaemia • Chronic lymphocytic leukaemia
ALL
Which of the main leukaemias inmost common in adults overall and is associated with warm haemolytic anaemia., pitcher transformation into lymphoma and smudge cells • Acute myeloid leukaemia • Acute lymphoblastic leukaemia • Chronic myeloid leukaemia • Chronic lymphocytic leukaemia
CLL
which of the main. leukaemias has 3 phases including a 5 year 'asymptomatic chronic phase' and is associated with the Philadelphia chromosome • Acute myeloid leukaemia • Acute lymphoblastic leukaemia • Chronic myeloid leukaemia • Chronic lymphocytic leukaemia
CML
which is the main leukaemias is associated with Auer rods • Acute myeloid leukaemia • Acute lymphoblastic leukaemia • Chronic myeloid leukaemia • Chronic lymphocytic leukaemia
AML
What is tumour lysis syndrome
causes by the release of uric acid from cells that are being destroyed by chemotherapy
uric acid can form crystals in interstitial tissue and tubules of the kidney and can cause AKI
- Allopurinol or rasburicase are. used. to reduced the high uric acid levels
- potassium and phosphate can also be released so these need to be monitored. as high potassium can lead to low calcium
What is a multiple myeloma
a malignancy arising from plasma cells
plasma cells are WBC that is. for antibody production in response to an infection
If a proliferating nest of plasma cells deposit in bones what can this cause (what would you see on an x ray)
osteolytic lesions
How. does multiple myeloma affect other cells
in the bone marrow proliferation. of plasma cells result in reduced erythropoiesis and reduced production of platelets (thereby causing anaemia and thrombocytopaenia)
- also produces various paraproteins that may be detected in the plasma or urine
what are the 4 features of myeloma
You can use the mnemonic CRAB to remember four key features of myeloma:
C – Calcium (elevated)
R – Renal failure
A – Anaemia (normocytic, normochromic) from replacement of bone marrow.
B – Bone lesions/pain
what are Bence Jones proteins
monoclonal globulins that may be detected in urine in patients with multiple myeloma
these are present in approx 60% of patients with multiple myeloma
