3 - myeloid & lymphoid leukaemia

Question 1

what cell types are associated with leukaemias?

Answer 1

group of blood cancers associated with increase in white blood cells

Question 2

what are the 2 types of acute leukaemias?

Answer 2

1. acute myeloid leukaemia (AML)
2. acute lymphoblastic leukaemia (ALL)

Question 3

what are the 2 types of chronic leukaemias?

Answer 3

1. chronic myeloid leukaemia (CML)
2. chronic lymphocytic leukaemia (CLL)

Question 4

what is acute leukaemia? what is buzzwordy thing

Answer 4

= proliferation of primitive progenitors, blocked maturation.

excess of blasts = buzzword for acute leukaemia

Question 5

what is acute lymphoblastic leukaemia?

Answer 5

= accumulation of lymphoblasts (lymphoid progenitors) - maturation problem so no T & B lymphocytes

= it’s the most common childhood cancer

Question 6

what is acute myeloid leukaemia?

Answer 6

= accumulation of myeloblasts. get no RBCs, no WBC, no platelets - since no maturation

• more in older people, can happen randomly (de novo)

Question 7

what is clinical presentation of acute leukaemias?

Answer 7

both have marrow failure so anaemia (consequence no RBCs), infections (consequence no WBC), bruising (consequence no platelets)

ALL = also has CNS & testes involvement

Question 8

what are investigations for acute leukaemia?

Answer 8

1. blood count & blood film
2. coagulation screen for DIC (can be in acute myeloid leukaemia
3. bone marrow biopsy

Question 9

what is auer rod on blood film?

Answer 9

suggests acute myeloid leukaemia

Question 10

what is definitive diagnosis for leukaemias?

Answer 10

immunophenotyping

Question 11

what is treatment for acute leukaemias?

Answer 11

• supportive blood products
• different chemo - ALL and AML both have different types and lengths treatment
• can get allogeneic (bone marrow) stem cell transplant

Question 12

what is Hickman line?

Answer 12

central line going into subclavian vein sitting between SVC & RA = good as stays in for months

Question 13

what are 3 big problems of bone marrow suppression? (like symptoms)

Answer 13

1. anaemia
2. neutropenia - severe infections. especially sepsis from gram -ve (need urgent antibiotics)
3. thrombocytopenia - bleeding showing as purpura or petechiae

Question 14

what infections are people with acute leukaemia especially susceptible to?

Answer 14

all infections but particularly gram -ve as can cause life threatening sepsis, if infective then give immediate antibiotics. if don’t make effect then think about fungal infection like aspergillus

Question 15

what are complications of chemo treatment for acute leukaemia?

Answer 15

• nausea & vomiting
• hair loss
• liver & renal dysfunction
• tumour lysis syndrome (tumour cells die releasing toxic chemicals)
• infection, sepsis since make immunocompromised
• pneumocystitis pneumonia is risk

*long term can get loss fertility & cardiomyopathy if use anthracyclines (chemo drug)

Question 16

what is chronic myeloid leukaemia? what causes? what is unusual about first few years?

Answer 16

= clonal stem disorder of primitive compartment

• caused by philadelphia chromosome translocation from 9 to 22 (BCR-ABL1 re-arrangement)
• first 3-5yrs there is preserved maturation so lots made but all normal functioning, then will just randomly change and maturation stops meaning build up of blasts

Question 17

what is chronic lymphocytic leukaemia?

Answer 17

= clonal lymphoproliferative disorder of mature B lymphoid

• infiltrates blood & bone marrow
• it’s most common type adult leukaemia, slower pace of diagnosis

Question 18

what is presentation of chronic lymphocytic leukaemia?

Answer 18

= often no symptoms since slow working

• can have symptoms of areas affected e.g. lymph node, spleen enlargement, bone marrow infiltration

Question 19

what is buzzword for chronic lymphocytic leukaemia? (histology)

Answer 19

smear cell = fragile cells that splatter membrane so look like smudges

Question 20

what is treatment for chronic lymphocytic leukaemia?

Answer 20

• can be no treatment
• can just be supportive blood products
• would treat more aggressively like cancer if night sweats, fever, weight loss, spleen or lymph node problems etc

*it’s incurable disease but can have long life, also targeted treatments that help symptoms