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Essential Haematology > 9. Acute leukemias > Flashcards

9. Acute leukemias Flashcards

1
Q

Define Leukemias

A

They are a group of disorders characterized by the accumulation of malignant white cells in the bone marrow and blood

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2
Q

What are the four classifications of Leukemia

A

Acute lymphoid Leukemia
Acute myeloid Leukemia
Chronic Lymphoid Leukemia
Chronic Myeloid Leukemia

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3
Q

Describe the onset of Acute Leukemias

A

Aggressive disease in which malignant transformation occurs in the haemopoietic cell or early progenitors (blast cells)

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4
Q

What is the most common clinical feature of Acute Leukemias

A

Bone marrow failure

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5
Q

What causes bone marrow failure in Acute Leukemia

A

Caused by accumulation of blast cells in addition to organ infiltration

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6
Q

Define Acute Leukemia

A

The presence of over 20% of blast cells in the blood or bone marrow at clinical presentation

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7
Q

What are the two subdivisions of Acute Leukemias

A

Acute Myeloid Leukemia (AML)

Acute Lymphoblastic Leukemia (ALL)

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8
Q

What is the Morphological difference between ALL and AML

A

In ALL the blasts show no differentiation (with the exception of B-cell) whereas in AML some evidence of differentiation to granulocytes or monocytes is seen

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9
Q

What causes Acute Lymphoblastic Leukemia

A

An accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood

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10
Q

What is the most common malignancy of childhood

A

Acute Lymphoblastic Leukemia

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11
Q

What is the incidence of Acute Lymphoblastic Leukemia (ALL)

A

3-7 yrs

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12
Q

Based on morphology, what are the three subtypes of ALL (Acute Lymphoblastic Leukemias)

A

L1
L2
L3

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13
Q

Describe L1 ALL

A

Uniform, small blast cells with scanty cytoplasm

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14
Q

Describe L2 ALL

A

Type comprise larger blast cells with more prominent nucleoli and cytoplasm and more heterogeneity

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15
Q

Describe L3 ALL

A

Blasts that are large with prominent nucleoli, strongly basophilic cytoplasm and cytoplasmic vacuoles

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16
Q

What are the four subtypes of ALL based on Immunophenotype

A

Early pre B
Pre B
B- cell
T- cell

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17
Q

What are the two main features of ALL(Acute Lymphoblastic Leukemia)

A

Bone Marrow Failure

Organ Infiltration

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18
Q

What are three effects of Bone Marrow Failure

A

Anaemia
Neutropenia
Thrombocytopenia

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19
Q

What are three clinical features of Anemia

A

Pallor
Lethargy
Dyspnoea

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20
Q

What are three clinical features of neutropenia

A

Fever
Malaise
Mouth, throat, skin, respiratory, perianal infections

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21
Q

List four clinical features of Thrombocytopenia

A

Spontaneous bruises
Purpura
Bleeding gums
Menorrhagia

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22
Q

What are five common manifestations of Organ infiltration

A 
Tender bones
Lymphadenopathy 
Moderate Splenomegaly
Hepatomegaly
Meningeal Syndrome
23
Q

What are five symptoms of Meningeal syndrome

A 
Headache
Diplopia
Blurred vision
Nausea
Vomiting
24
Q

What are the results of haematologic tests in ALL and AML

A

Normochromic
Normocytic
Thrombocytopenia
Total White Cell count may be decreased, normal or increased

25
Q

What are the results of Blood film Examination in ALL and AML

A

Variable number of blast cells

26
Q

What are the features of the bone marrow in ALL and AML

A

Hypercellular with >20% leukemia blasts

27
Q

What is the result of Lumbar Puncture in ALL and AML

A

Spinal fluid has increased pressure

Spinal fluid contains leukemic cells

28
Q

What is the result of Biochemical tests for ALL and AML

A

Raised serum uric acid

Raised serum lactate dehydrogenase

29
Q

List some differential diagnosis for ALL

A 
AML
Aplastic anemia
Marrow infiltration by other malignancy 
Infections
Juvenile Rheumatoid Arthritis
30
Q

B- ALL always has which ALL morphology

A

L3

31
Q

What are two types of treatment for ALL

A

General Supportive therapy

Specific Therapy

32
Q

Describe Specific Therapy of ALL

A

Chemotherapy

Radiotherapy

33
Q

What is the aim of Remission Induction

Type of Specific Treatment for ALL

A

Rapidly kill most of the tumour cells and get the patient into remission.

34
Q

Which drugs are used for remission induction treatment of ALL

A

Prednisolone or Dexmethasone (in children)

Vincristine
Asparaginase

35
Q

Describe Intensification (consolidation) treatment for ALL

A

Uses high doses of multidrug

chemotherapy in order to completely reduce or eliminate the tumour burden to very low levels

36
Q

What percentage of Acute Lymphoblastic Leukemias occur in children

A

80%

37
Q

What percentage of Acute Lymphoblastic Leukemias occur in adults

A

20%

38
Q

What percentage of Acute Myeloid Leukemias occur in children

A

20%

39
Q

What percentage of Acute Myeloid Leukemias occur in adults

A

80%

40
Q

What are 5 risk factors for leukemia

A 
Ionizing radiation
Benzene
Down's Syndrome
Chronic Smoking
Klinefelter syndrome
41
Q

T- ALL is most common in which sex

A

Males

42
Q

What is the prognosis of ALL in children

A

Usually good

~90% of children can expect to be cured

43
Q

What is the prognosis of ALL in adults

A

Poor

Adults over 70 yrs have <5% cure rate

44
Q

What is the common form of Leukemia in adults

A

Acute Myeloid Leukemia AML

45
Q

What fraction of childhood leukemias does Myeloid Leukemia form

A

10-15%

46
Q

What are the two main types of Acute Myeloid Leukemia

A

Primary AML

Secondary AML

47
Q

What is the genetic abnormality seen in Primary AML

A

Chromosomal translocations of t(8;21)

And t(15;17)

48
Q

What is the prognosis of primary AML

A

Good

49
Q

What are the clinical features of AML

A

Anaemia
Thrombocytopenia
neutropenia

50
Q

List one problem that is unique to AML and not ALL

A

Haemorrhagic syndrome

associated with the AML M3 variant

51
Q

Haemorrhagic syndrome unique to AML is associated with which variant

A

M3 variant

52
Q

How is Haemorrhagic Syndrome of AML treated

A

Multiple platelet transfusions

Replacement of clotting factors with fresh frozen plasma

53
Q

CASE HISTORY//

6 yr old female with fever for 3 weeks, less active, easily tired, bleeding gums and easy bruising for 1 week

Physical Examination

  • pale, febrile, tenderness over sternum
  • multiple haemorrhagic lesions
  • cervical nodes enlarged, non- tender
  • spleen enlarged

BLOOD RESULTS//

Hb 6.0 g/dl blood film - normochromic / normocytic
Platelets : 12 x 10^9/L
WBC : 85 x 10^9/L
Chest X ray : enlarged nodes
Bone marrow: 90% blasts with few erythroid and megakaryocyte precursors

A

Leukemia

Essential Haematology (14 decks)

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