Acute leukaemia Flashcards
Test tube of blood from normal person vs that of a patient with leukaemia
leukaemia patients tube has huge “pussy” layer of white blood cells in between RBC’s and serum, this layer is hard to see in the normal blood tube
The categories of blood cancers
- leukaemias
- myeloproliferative neoplasms (polycythemia, too many RBC’s, blood is thick and sticky = headaches and lethargy) (key locular changes that cause increased proliferation of the different myeloid blood lineages but they differentiate and mature in a normal way
- Lymphomas (Hodgkins and Non- Hodgkins)
- Myelomas (colonel proliferation of cancer cells that replace bone marrow, release cytokines that inc bone marrow lysis)
Progression of leukaemia
proliferation of immature bone marrow cells
Expand and replace normal bone marrow cells
Abnormal leukaemic cells spill over into blood
the difference between chronic and acute leukaemia
acute - abnormal cells are blasts that remain very immature and cannot carry out their normal functions. number of blasts increases rapidly, and the disease gets worse quickly.
chronic some blast cells are present, cells are more mature and can carry out some of their normal functions. number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia gets worse gradually.
arise in either of the two main types of white blood cells–lymphoid cells or myeloid cells. When leukemia affects lymphoid cells, it is called lymphocytic leukemia. When myeloid cells are affected, the disease is called myeloid or myelogenous leukemia.
The 4 main types of leukaemia and the most common associable demographic
Acute lymphocytic leukemia (ALL) predominantly children
Acute myeloid leukemia (AML) predominantly adults
Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55.
Chronic myeloid leukemia (CML) occurs mainly in adults. A very small number of children
Risk factors for leukaemia
Congenital / inherited (most leukaemia not familial / inherited but some congenital disorders increase the risk e.g. Downs syndrome)
Viral Infections (proven with animal models, one rare virus in Africa can cause it)
Radiation (post atomic bombs and chernobyl, and a result of therapeutic radiation treatment for other cancers, especially when used in conjunction with chemo)
Chemical / DNA damaging drugs
Example of targeted therapy
Philadelphia chromosome found in CML and some cases of acute leukaemia Imantinib developed (competes with ATP binding site and blocks phosphorylation of downstream tyrosine residues) Life expectancy of those with CML is now almost the same as that of the general population
How does leukaemic bone marrow look different
Heaps of small pink staining cancer cells, no more fat cells
Signs and symptoms due to bone marrow failure
Anaemia, fatigue, dyspnoea (laboured breathing), cheast pain
Exacerbation of underlying respiratory and cardiac conditions
Neutropenia -infection of wounds, slow to heal –> failure of production of normal cells
Thrombocytopenia - bruising and bleeding
Leukemia full blood count diagnosis
low Hb/ anaemia
White cells increased due to circulating blasts (leukaemia cells), neutrophils low
Severe thrombocytopenia - often less than 20x10^9(150-400)
What else do you do to diagnose leukaemia
Bone marrow biopsy aspirate trephine from posterior iliac crest If >20% blasts then BAD
Specialised testing
- Immunophenotype
- Chromosomes (some chromosome changes have a good prognosis, others bad)
- Molecular studies
Acute leukaemia: therapy
Intensive transfusion support - Red cells - Platelets Management of infection - ID and lab support, antibiotic therapy Vascular access - tunnelled venous catheters Patient and family support
Chemotherapy for acute leukaemia
Induction therapy - to induce remission
Consolidation - to mop up residual leukaemia cells
Maintenance therapy (only in ALL) - to keep patient in remission
Types of haematopoietic stem cell transplantation
Autologous - own stem cells taken out in remission (mainly for lymphomas and myelomas)
Allogenic - matching sibling or unrelated donor
Stem cells = bone marrow, peripheral blood or cord blood