Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Week 3 - haematology > Acute Leukaemia > Flashcards

Acute Leukaemia Flashcards

1
Q

What is leukaemia?

A

A blood cancer resulting in accumulation of white cells (leucocytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the classifications of leukaemia?

A
  • Leukaemia is chronic or acute
  • Acute can be myeloid (acute myeloid leukaemia) or lymphoid (acute lymphoid leukaemia)
  • Chronic leukaemia can be lymphoid or myeloid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the symptoms of chronic leukaemia dependent on?

A

The accumulation of cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of an acute leukaemia dependent on?

A

Symptoms are from marrow failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the pre-leukaemic conditions?

A
  • MDS- myelodysplastic syndrome

* MPDs- Myeloproliferative disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is MDS characterised by?

A
  • Failure of effective haemopoiesis (low blood count)
  • Most common in elderly
  • ‘dysplastic’ blood and marrow appearances
  • Consequences of marrow failure - i.e. bleeding and infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the transformation rate of MDS to AML?

A

approx rate of transmission is 25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can low risk vs low risk MDS be established?

A
  • Proportion of blast cells in the marrow

* Number and severity of cytopenias and cytogenic profile (chromosomal abnormalities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the management of MDS?

A
  • No cure other than a stem cell transplant (<65-70 years)
  • supportive care
  • Consider drug therapy e.g. azacitidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What mutation is prevalent in MPDs?

A

JAK2 mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are MPDs characterised by?

A
  • Too many platelets - essential thrombocythaemia
  • Too many red cells - polycythaemia vera
  • Too much fibrous tissue - myelofibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain myelofibrosis

A
  • Large spleen
  • Systemic symptoms
  • Blood counts high or low
  • Incurable other than with stem cell transplant
  • Targeted therapy = JAK2 inhibitors

I think it is a chronic leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are acute leukaemias?

A
  • Clonal disorders leading to blastic proliferation in the bone marrow
  • Rapid in onset - die in days or weeks if not treated
  • Serious compromise of normal marrow elements (so normal counts fall)
  • Death within days or weeks if untreated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the acute myeloid leukaemias?

A
  • Erythroleukaemia
  • Myeloid leukaemia
  • Monocytic leukaemia
  • Megakaryocytic leukaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the acute lymphoid leukaemias?

A
  • T lymphoblastic leukaemia

* B lymphoblastic leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the difference in age presentation between acute myeloid and acute lymphoid leukaemias?

A
  • Acute myeloid leukaemias increase in prevalence with age

* Acute lymphoid leukaemias peak in early childhood

17
Q

What is the aetiology of a leukaemia?

A
  • Largely unknown
  • Chemicals
  • Chemotherapy
  • Radiotherapy
  • Genetic - Down’s syndrome or Fanconi Syndrome
  • Antecedent blood disorders (MDS, MPD)
  • Infection: lack of exposure in infancy and aberrant response in later childhood important in child hood ALL
18
Q

Explain diagnosis of acute myeloid leukaemia from history

A
  • Rapid onset of symptoms
  • Short history of marrow failure
  • Anaemia - fatigue
  • Leukopenia - fever and infection
  • Thrombocytopenia - bleeding/bruise
19
Q

What are the findings on examination in someone with Acute myeloid Leukaemia?

A
  • Lethargy
  • Infection
  • Bleeding and bruising
  • Bone pain
  • Gum swelling
  • Lymphadenopathy, skin rash
20
Q

Describe peripheral blood in acute myeloid leukaemia

A
  • Anaemia
  • Neutropenia
  • Thrombocytopenia
  • Blasts
21
Q

What do blasts look like?

A
  • High nuclear cytoplasmic ratio

* Not a lot of cytoplasm

22
Q

Explain the diagnosis of acute myeloid leukaemia from bone marrow

A

•Blast cells >20%

23
Q

Explain which diagnosis it is important to look for in the bone marrow in an acute leukaemia

A
  • M3 AML - acute promyelocytic leukaemia
  • Key sign is bundle of cells with rods in the cytoplasm
  • Can have significant bleeding so need a targeted therapy
  • t(15:17)
24
Q

When is there a poor prognosis of AML?

A
  • Secondary AML
  • Relapsed AML
  • MDS transformed to AML
  • Biphenotypic disease
  • Elderly patients
  • Refractory to induction
25
Q

What is the management of AML?

A
  • Intensive chemotherapy ± stem cell treatment (patient less than 60-65)
  • Low dose chemotherapy (patients older than 60-65)
  • Supportive care only (older patients, major co-morbidities, median survival 3-6 months) i.e. blood transfusion, manage infection with antibodies
  • Most young patients are entered into clinical trials
26
Q

What are the impacts of chemotherapy

A
  • High morbidity- bleeding and infection
  • Hair loss
  • Sterility
  • Muscositis
  • Prolonged inpatient stays
  • Psychological element
27
Q

Describe the clinical presentation of acute lymphoid leukaemia

A
  • Limping child
  • Purpuric rash (low platelets)
  • Unexplained, sometimes severe, bone pains not uncommon
28
Q

What are the 3 recognised subtypes of ALL?

A
  • L1
  • L2
  • L3
29
Q

What are the standard cytogenetics of ALL?

A
  • t(9:22) - Philadelphia chromosome

* t(4:11)

30
Q

What is the management of ALL?

A
  • Complex, specialist units
  • Chemotherapy: prednisolone, cyclophosphamide, vincristine, etoposide based
  • CNS directed treatment is essential
  • Initial aggressive therapy then oral maintenance for 1-2 years
31
Q

What is the management of relapsed ALL?

A
  • Blinatumomab - targets CD19 on B cells

* CAR T cells - if not responding to blinatumomab (own T cells used)

32
Q

What is the supportive management of acute leukaemia?

A
  • Blood transfusion in symptomatic patients
  • Fresh frozen plasma for coagulopathy/DIC
  • Platelet transfusion
  • Antibiotics
  • Growth factors
  • Granulocytes
33
Q

What are the complications of acute leukaemia?

A
  • Purpura skin rash
  • Retinal haemorrhage
  • Viral infection
  • Bacterial and fungal infection
34
Q

Which patients with acute leukaemia are considered for a transplant?

A
  • Relapsed patients
  • Refractory patients
  • Poor risk disease in first CR (complete remission)
  • Age less than 60
  • Good performance

Week 3 - haematology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions