3: Concepts in malignant haematology Flashcards
How are
a) lymphoid
b) non-lymphoid white cells identified?
a) Immunophenotyping
b) Morphology
How are progenitor blood cells identified?
Immunophenotyping
What occurs in malignant haemopoiesis?
Increased numbers of dysfunctional cells
Loss of normal activity
What problems occur in acute leukaemia?
Proliferation of ABNORMAL PROGENITOR CELLS
which DON’T DIFFERENTIATE OR MATURE
Which two processes fail to occur in acute leukaemia?
Differentiation
Maturation
What is the difference between acute leukaemia and chronic myeloproliferative disorders?
Acute leukaemia - proliferation of progenitor cells, NO DIFFERENTIATION OR MATURATION
Chronic myeloproliferative disorder - proliferation of progenitor cells, continued differentiation and maturation
What is a clone?
Population of cells derived from a single parent cell
A clone will have the same genetic ___ as its parent cell.
markers
How is normal haemopoiesis described in terms of clones?
Polyclonal
Blood cells come from a variety of parent cells
How is malignant haemopoiesis described in terms of clones?
Monoclonal
Cells derived from one abnormal parent cell
Malignant haemopoiesis has a strong __ component.
genetic component
What are the two lineages of haematological malignancy?
Myeloid
Lymphoblastic
What are malignant blood cancers called when the
a) blood
b) lymph nodes are involved?
a) Leukaemia
b) Lymphoma
What is myeloma?
Plasma cell malignancy IN the bone marrow
unfortunate naming not to be confused with myeloid leukaemias
Acute leukaemias tend not to involve the ___ ___.
lymph nodes
Chronic lymphoid leukaemias affect the ___ and ___ ___.
blood
bone marrow
but otherwise leukaemia means blood and lymphoma means lymph nodes
Acute leukaemia causes the ___ ___ to fail.
bone marrow failure
because differentiation and maturation stop dead
Describe the speed of onset of acute and chronic haematological malignancies.
Acute leukaemia - quick onset
Chronic - onset over weeks to months
Which cells are affected in
a) myeloid malignancy
b) lymphoblastic malignancy
c) myeloma?
a) Non-lymphoid cells and their progenitors
b) Lymphoid cells and their progenitors
c) Plasma cells
Which type of blood cancer is aggressive and rapidly progressing?
Acute leukaemia
Acute leukaemia causes a LOSS OF HAEMOPOIETIC RESERVE.
Which investigation gives this away?
FBC
low platelets, white cells and RBCs
Which malignancy affects primitive lymphoid cells?
Acute lymphoblastic leukaemia
What is the most common childhood cancer?
Acute lymphoblastic leukaemia (ALL)
What are the signs and symptoms of bone marrow failure caused by acute leukaemia?
Anaemic symptoms (fatigue, pallor, SOB, syncope, palpitations)
Abnormal bleeding
Increased infection risk
What is unique about the presentation of ALL?
Involvement of CNS, gonads i.e structures outwith the bone marrow
Which acute blood malignancy primarily affects
a) children
b) adults?
a) Acute lymphoid leukaemia
b) Acute myeloid leukaemia
Which coagulation problem is associated with acute myeloid leukaemia?
DIC
How is acute leukaemia investigated?
Full blood count
Blood film
Coagulation screen (PT, APTT)
Bone marrow aspirate
What do primitive progenitor cells look like on a blood film?
High nuclear:cytoplasmic ratio
Dodgy looking
What is a blood film finding specific to AML?
Auer rods
AML and ALL look similar morphologically.
How do you tell them apart?
Immunophenotyping
How might you tell the difference between AML and ALL morphologically?
Auer rods specific to AML
but not there all the time
Why is it important to determine whether a leukaemia is myeloid or lymphoblastic?
Different treatments
How is acute leukaemia (ALL or AML) treated?
Chemotherapy
Acute leukaemia AND the chemotherapy used to treat it cause bone marrow suppression.
What are the complications of this?
Anaemia
Neutropaenia > Infection
Thrombocytopaenia > Bleeding
Patients undergoing chemotherapy for acute leukaemia are susceptible to which infection?
Gram negative bacteria
E. coli, Pseudomonas, Neisseria, Haemophilus, Chlamydia…
Apart from bone marrow suppression, what are the generalised side effects of chemotherapy?
N&V
Hair loss
Lethargy
Hepatic and renal dysfunction
What is tumour lysis syndrome?
Metabolic and electrolyte disturbances caused by tumour lysis in chemotherapy
What do you do if a patient undergoing chemotherapy has neutropaenia and a fever?
Empirical antibiotic treatment
Empirical anti-fungal treatment if they don’t respond to that
What is an important side effect of anthracycline chemotherapy?
Cardiomyopathy
A subtype of which acute leukaemia is associated with coagulopathy?
Which specific coagulopathy?
AML
DIC
