Acute Leukaemia (ALL and AML)

Question 1

What type of cells proliferates, which if you saw in an acute presentation, should have you thinking of acute leukaemia?

What does ALL and AML stand for?

Answer 1

Immature blast cells

Acute lymphoblastic leukaemia
Acute myeloid leukaemia

Question 2

What type of progenitor cells proliferates in ALL and AML?

Answer 2

ALL - progenitor lymphocytes

AML - progenitor granulocytes

Question 3

What age group does ALL tend to occur in?

What age group does AML tend to occur in?

Answer 3

Children

Adults

Question 4

S+S:

Cytopaenia due to bone marrow failure:

• What symptoms do they get with anaemia? - 3
• What will they get with infections even with raised WBC?
• What types of bleeding may they have?

Cytopenia occurs when one or more of your blood cell types is lower than it should be.

Answer 4

Fatigue
Pallor
SOB

Although patients with leukaemia may have very high white blood cell counts, the leukaemia cells don’t protect against infection the way normal white blood cells do. Neutropenia means that the level of normal neutrophils is low.

Fever
Mouth ulcers
Infection symptoms - cough, dysuria

Bruising
Menorrhagia
Internal bleeding - Intracranial
DIC

Question 5

S+S:

Organ infiltration:

• What organs become enlarged?
• What else become enlarged which allows cancer to metastasise?

Organ infilatration:

• What are some signs of CNS mets? (especially ALL)
• Testes may swell. What is this called? (especially ALL)
• What may happen to the gums? (especially AML)
• What happens in the skin?

Answer 5

Liver and spleen - hepatosplenomegaly

Lymphadenopathy 
======
CN palsy 
Papilloedema - due to raised ICP
Mennigism 

Orchidomegaly

Gum hypertrophy

Skin nodules

Question 6

Risk factors - list some?

What genetics disease could increase the risk?

Answer 6

Radiation exposure
Previous haematological disease

DOWN’S SYNDROME

Question 7

Investigations:

What condition will FBC show if there is bone marrow failure?

Why is coag important to do?

Blood film:

• What calls are found in ALL?
• What calls are found in AML?

Why may LFTs and U&Es need to be done?

Why is the enzyme LDH raised?

What imaging can be done for organ infiltration?

Answer 7

Pancytopenia - everything low - WBC might seem high

May find DIC

Lymphoblasts

Myeloblasts

To check baseline before chemotherapy

In acute leukaemia level of lactate dehydrogenase elevated due to the cell destruction and tumour turnover. Elevated LDH is an unfavorable prognostic factor for several malignancies, including acute leukaemia.

CXR
CT
LP

Question 8

Diagnosis:

What can be done for a definite diagnosis?

Answer 8

Bone marrow biopsy

Question 9

Management:

Supportive:
- What is done for pancytopenia?

Chemotherapy:

• How long is chemo for ALL?
• How long is chemo for AML?

What can be used in high-risk patients?

Answer 9

RBC and platelet transfusion
Antibiotics due to immunosuppression
Neutropenic regimen could be started

ALL - up to 3 yrs
AML - 6-8 months

Stem cell transplants
Bone marrow transplants

Question 10

Iatrogenic complications - list some

What about in kids?

Answer 10

Infertility, especially in males, so sperm baking advised

Nausea and vomiting

Bone marrow failure

Short stature
Low IQ

Question 11

Myelodysplastic syndrome (MDS):

What is it?

Why is it important?

Answer 11

Progressive marrow failure due to production of dysfunctional (dysplastic) blood cells

It is a premalignant of leukaemia