Acute Leukaemia Flashcards
Definition
Rapidly progressive Clonal malignancy of the marrow/blood Maturation defect(s) Excess of blasts in either - peripheral blood - bone marrow
Excess of blasts means more than __% ?
20% or more in excess
Name 2 types of acute leukaemia
Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)
What happens to the haemopoietic reserve?
There is loss of the haemopoietic reserve resulting in a pancytopenia
- low red cells
- low platelets
- low neutrophils
What are the 3 things that make up pancytopenia ?
Low red cells
Low platelets
Low neutrophils
ALL - definition
Malignant disease of primitive lymphoid cells (i.e. lymphoblasts)
What is the most common childhood cancer?
ALL
ALL - clinical features
Anaemia, infections, bleeding
- Due to marrow failure
High count with obstruction of circulation. Involvement of areas outside the marrow and blood (extra-medullary) e.g. CNS, Testis
- Due to leukaemia effects
Bone pain
- due to expansion of bone marrow
Which type of acute leukaemia is more common in the elderly?
AML
AML - clinical features
Anaemia
Infections
Bleeding
- Marrow failure
Why is there marrow failure in acute leukaemia
Compromise the normal bone marrow due to proliferation of primitive cells…thus, mature cells are not really being made.
Which coagulation deficit can AML be associated with?
DIC
Investigations for acute leukaemia
- Blood count and film
- reduction in normal features
- monomorphic appearance
- presence of abnormal features (blasts with high NC ratio) - Coagulation screen
- Bone marrow aspiration
Investigations for acute leukaemia - what abnormal features may be present on blood count/blood film in AML?
Auer rod
- granules which have condensed and joined up together
- they are found within the blasts
What are Auer rods seen in?
AML
Investigations for acute leukaemia - bone marrow aspiration - what are the MORPHOLOGY differences between AML and ALL ?
There are no morphological differences between the two
Investigations for acute leukaemia - bone marrow aspiration - since there are no morphological differences between AML and ALL, what investigation is done on the bone marrow aspiration to make a definitive diagnosis?
Immunophenotyping
- look for lineage specific proteins on the cell surface
What investigation is required for definitive diagnosis of AML or ALL ?
Immunophenotyping
What may be helpful to assess cellularity when the bone marrow aspirate is sub-optimal?
Trephine (piece of bone)
Management overview for acute leukaemia?
Multi agent chemotherapy
ALL - management
Chemotherapy usage can last up to 2-3 years
Different phases of treatment of varying intensity
AML - management
Ususally intensive chemotherapy Prolonged hospitalisation 2-4 cycles of chemotherapy - 5-10 days of chemo followed by 2-4 weeks recovery
What is the name of the central line which treatment can be administered via?
Hickman line
Hickman line can only be used to administer treatment. True or false?
False
- can be used to take blood and give blood products
What is a main side effect of chemotherapy
Bone marrow suppression
What are problems of bone marrow suppression caused by chemotherapy?
Anaemia
Neutropenia - infections
Thrombocytopenia - bleeding, purpura, petichae
Which type of bacteria can cause life threatening sepsis in neutropenic patients?
Gram NEGATIVE bacteria
Who has better cure rate of ALL : children or adults?
Children
85-90% cure rate compared to adult 30-40% cure rate
Aside from chemotherapy, what are other treatment options for acute leukaemia?
Targeted treatments
- molecular targeting with kinase inhibitors
Allogenic stem cell transplantation
Suspect leukaemia in a patient. What is the first line investigation
FBC
What is the main investigation for establishing a diagnosis in leukaemia?
Bone marrow biopsy
Where is bone marrow biopsy usually taken
Iliac crest
Acute lymphocytic leukaemia is associated with which chromosome
Philadelphia chromosome
Auer rods makes you think
AML
Which medication is used in the management of tumour lysis syndrome?
Allopurinol
Rasburicase
