Acute leukaemia

Question 1

Natural history of Acute leukaemia

Answer 1

Result of accumulation of early myeloid and lymphoid precursors in the bone marrow, blood and other tissues.
Occurs by somatic mutation in a single cell within a population of early proginator cells
May arise de-novo in the terminal event of a pre-existing blood disorder / following chemo
Acute Myeloid Leukemia–> myeloid lineage e.g neutrophils, eosinophils
Acute lymphoblastic leukemia –> B & T cells etc

Question 2

Presenting clinical features of AL

Answer 2

features of bone marrow failure: anaemia, infections, easy bruising and haemorrhage.
Organ infiltration by leukaemia cells may occur e.g. spleen, liver, meninges, testes and skin
common infection eg staph aureus infection of the orbit in a patient with AML. can get gum hypertrophy and bleeding in groin area.

Question 3

Haematological features of AL

Answer 3

AML–> cells are monomorphic
ALL–> mainly nucleus
not developed cells. lack of diversity

Question 4

Diagnosis

Answer 4

Immunological markers–> monoclonal antibody determination of surface antigen expression
Cytogenetics –> certain abnormalities correlate with prognosis eg translocaiton t(8;21) and t(15: 17) in AML = good prognosis.
monosomy 7 in AML and t(9;22) = bad prognosis

Question 5

risk factors

Answer 5

• male
• old age (children recover very well)
• poor response to treatment due to genetics
• higher white cell count

Question 6

management AML

Answer 6

induction treatment to obtain remission, the consolidaiton of further courses of combination chemo.
in younger patients consider bone marrow transplant (sibling best)

Question 7

management ALL

Answer 7

All patients receive induction chemo, then consolidation chemo then prophylaxis of meningeal leukaemia with intrathecal methotrexate and cranial irradiation. bone marrow in bad risk patients required but risky procedure.

Question 8

recognize neutropenic sepsis

Answer 8

• first all patients recieveing intensive chemo will become neutropenic for 10-21 days so will need hygienic isolation.
  frequently the neutrophil count will fall to levels below 0.2 so can develop severe infections –> gram +/-ve
  FEVER (PYREXIA)

Question 9

treat neutropenic sepsis

Answer 9

try prevent with protective isolation, prophylatic antibiotics and use of granulocycte colony stimulating factors
TREAT: patietnt education and strict protocols for antimicrobial therapy.