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Haematology SOH > Acute Leukaemia > Flashcards

Acute Leukaemia Flashcards

1
Q

Definition

A 
Rapidly progressive 
Clonal malignancy of the marrow/blood 
Maturation defect(s) 
Excess of blasts in either 
- peripheral blood 
- bone marrow
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2
Q

Excess of blasts means more than __% ?

A

20% or more in excess

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3
Q

Name 2 types of acute leukaemia

A

Acute myeloid leukaemia (AML)

Acute lymphoblastic leukaemia (ALL)

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4
Q

What happens to the haemopoietic reserve?

A

There is loss of the haemopoietic reserve resulting in a pancytopenia

  • low red cells
  • low platelets
  • low neutrophils
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5
Q

What are the 3 things that make up pancytopenia ?

A

Low red cells
Low platelets
Low neutrophils

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6
Q

ALL - definition

A

Malignant disease of primitive lymphoid cells (i.e. lymphoblasts)

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7
Q

What is the most common childhood cancer?

A

ALL

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8
Q

ALL - clinical features

A

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

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9
Q

Which type of acute leukaemia is more common in the elderly?

A

AML

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10
Q

AML - clinical features

A

Anaemia
Infections
Bleeding
- Marrow failure

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11
Q

Why is there marrow failure in acute leukaemia

A

Compromise the normal bone marrow due to proliferation of primitive cells…thus, mature cells are not really being made.

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12
Q

Which coagulation deficit can AML be associated with?

A

DIC

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13
Q

Investigations for acute leukaemia

A
  1. Blood count and film
    - reduction in normal features
    - monomorphic appearance
    - presence of abnormal features (blasts with high NC ratio)
  2. Coagulation screen
  3. Bone marrow aspiration
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14
Q

Investigations for acute leukaemia - what abnormal features may be present on blood count/blood film in AML?

A

Auer rod

  • granules which have condensed and joined up together
  • they are found within the blasts
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15
Q

What are Auer rods seen in?

A

AML

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16
Q

Investigations for acute leukaemia - bone marrow aspiration - what are the MORPHOLOGY differences between AML and ALL ?

A

There are no morphological differences between the two

17
Q

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?

A

Immunophenotyping

- look for lineage specific proteins on the cell surface

18
Q

What investigation is required for definitive diagnosis of AML or ALL ?

A

Immunophenotyping

19
Q

What may be helpful to assess cellularity when the bone marrow aspirate is sub-optimal?

A

Trephine (piece of bone)

20
Q

Management overview for acute leukaemia?

A

Multi agent chemotherapy

21
Q

ALL - management

A

Chemotherapy usage can last up to 2-3 years

Different phases of treatment of varying intensity

22
Q

AML - management

A 
Ususally intensive 
chemotherapy 
Prolonged hospitalisation 
2-4 cycles of chemotherapy 
- 5-10 days of chemo followed by 2-4 weeks recovery
23
Q

What is the name of the central line which treatment can be administered via?

A

Hickman line

24
Q

Hickman line can only be used to administer treatment. True or false?

A

False

- can be used to take blood and give blood products

25
Q

What is a main side effect of chemotherapy

A

Bone marrow suppression

26
Q

What are problems of bone marrow suppression caused by chemotherapy?

A

Anaemia
Neutropenia - infections
Thrombocytopenia - bleeding, purpura, petichae

27
Q

Which type of bacteria can cause life threatening sepsis in neutropenic patients?

A

Gram NEGATIVE bacteria

28
Q

Who has better cure rate of ALL : children or adults?

A

Children

85-90% cure rate compared to adult 30-40% cure rate

29
Q

Aside from chemotherapy, what are other treatment options for acute leukaemia?

A

Targeted treatments
- molecular targeting with kinase inhibitors

Allogenic stem cell transplantation

30
Q

Suspect leukaemia in a patient. What is the first line investigation

A

FBC

31
Q

What is the main investigation for establishing a diagnosis in leukaemia?

A

Bone marrow biopsy

32
Q

Where is bone marrow biopsy usually taken

A

Iliac crest

33
Q

Acute lymphocytic leukaemia is associated with which chromosome

A

Philadelphia chromosome

34
Q

Auer rods makes you think

A

AML

35
Q

Which medication is used in the management of tumour lysis syndrome?

A

Allopurinol

Rasburicase

Haematology SOH (22 decks)

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