Acute Leukemias Flashcards
ACUTE LEUKAEMIAS: INTRODUCTION
______ of hematopoietic precursor cells, characterized by the accumulation of _______ in the ______
Neoplasms
excess blasts
bone marrow.
ACUTE LEUKAEMIAS: INTRODUCTION
Malignant _______ and _____ of ______ haemopoietic cells.
proliferation and accumulation
immature
ACUTE LEUKAEMIAS: INTRODUCTION
They are usually of (slow or rapid?) onset & are (slowly or rapidly?) fatal.
Rapid
rapidly
ACUTE LEUKAEMIAS: INTRODUCTION
They are subdivided into acute _______ and acute __________
lymphoblastic leukaemia (ALL)
myeloblastic leukaemia (AML).
ALL and AML can be further classified into subtypes
T/F
T
PATHOPHYSIOLOGY OF CLINICAL FEATURES of Acute leukemias
Pathophysiology follows:
1.______ failure due to _________ of its normal elements
2.________ of other _____
- leuko______
4.________ symptoms
5.other
Marrow failure; infiltration/ replacement
infiltration; organs
Stasis
Constitutional
PATHOPHYSIOLOGY OF CLINICAL FEATURES of Acute leukemias
Symptoms onset over _____ to ____ typically
days to weeks
PATHOPHYSIOLOGY OF CLINICAL FEATURES of Acute leukemias
Pathophysiology follows:
Marrow failure-
_______
————
________
anaemia
thrombocytopenia
neutropenia
PATHOPHYSIOLOGY OF CLINICAL FEATURES of Acute leukemias
Pathophysiology follows:Infiltration of other organs
-_____,______ ,______ (particularly in ALL): - _____,______ ,_______ , _____ masses (T-ALL)
- gums: -________(_____ subtype of ____)
-_____ pain especially in children with ____
- any organ or tissue
liver, spleen, lymph nodes; hepatomegaly, splenomegaly, lymphadenopathy
mediastinal
gum hypertrophy; monocytic; AML
bone; ALL
PATHOPHYSIOLOGY OF CLINICAL FEATURES of Acute leukemias
Pathophysiology follows: leukostasis
•only seen with WBC»_space;____ x 109/L
•in CNS: - ______
• in lungs: - ______,______
50
strokes
pulmonary infiltrates, hypoxemia
PATHOPHYSIOLOGY OF CLINICAL FEATURES of Acute leukemias
Pathophysiology follows: Constitutional symptoms
-______,_____are common
-_______ is relatively uncommon
fevers, sweats
weight loss
LABORATORY & DIAGNOSTIC INVESTIGATIONS of acute leukemia
Approach:
______ tests
_______ test
_______ tests
Initial
Confirmatory
Further
LABORATORY & DIAGNOSTIC INVESTIGATIONS of acute leukemia
Approach
Initial tests: ______ and __________ to determine ______ and the presence of _____
Complete blood count
peripheral blood smear
WBC count; blasts
LABORATORY & DIAGNOSTIC INVESTIGATIONS of acute leukemia
Approach
Confirmatory test: _______ and ______ to examine morphology, histochemistry, cytogenetics, and immunophenotyping
bone marrow aspiration and biopsy
LABORATORY & DIAGNOSTIC INVESTIGATIONS of acute leukemia
Approach
Further tests: if ______ is suspected (e.g., _____, _____ analysis, biochemistry – renal and liver function tests etc)
organ involvement
imaging
CSF
LABORATORY FEATURES: Hematologic indices:
Leukocytes: The white blood cell count (WBC) may be elevated, normal, or low and is a reliable diagnostic marker.
T/F
F
It is not
LABORATORY FEATURES : Hematologic indices
Anaemia – usually _____cytic
normo
LABORATORY FEATURES : Hematologic indices
Peripheral blood smear: presence of _____
blasts
LABORATORY FEATURES: Hematologic indices:
Coagulation studies: to rule out ____ especially in the _____ subtype _______ leukemia.
DIC
AML
promyelocytic
Features of acute leukaemia on bone marrow:
__________ marrow
Excess number of ______
Hypercellular
blasts
Acute Leukaemia is diagnosed when over _____% of nucleated cells in the bone marrow are blasts.
20
Although blasts are often readily identifiable in the peripheral blood, the key investigation to make the diagnosis of acute leukaemia before committing the patient to chemotherapy is __________________________
the bone marrow investigation
LABORATORY FEATURES
Bone marrow aspiration & biopsy is also helpful to:
_________ acute leukaemia
Obtain samples for _______
Sub-classify
cytogenetic analysis
Bone marrow aspirate and biopsy have only diagnostic value but no prognostic value
T/F
F
They have prognostic value in addition to diagnostic value
LABORATORY FEATURES
Other lab findings:
Electrolytes and metabolic markers:
___ PO42-
___ Ca2+
___ K+
___ Lactate dehydrogenase
____ uric acid
↑
↓
↑
↑
↑
LABORATORY FEATURES
Other lab findings:
X-ray may show ________ and _________ due to enlargement of the ____ and/or ________ in ALL
lytic bone lesions and mediastinal mass
thymus
mediastinal lymph nodes
DISTINCTION BETWEEN ALL
AND AML
Who has Auer rods
Who has cytoplasmuc granules
only AML blasts
only AML blasts
DISTINCTION BETWEEN ALL AND AML
-ALL is primarily a (pediatric or adult?) disease
-AML is primarily a (pediatric or adult?) disease
pediatric
adult
DISTINCTION BETWEEN ALL AND AML: Histochemistry
PAS
TdT
Myeloperoxidase
Positive ; negative
Positive ; negative
Negative ; positive
DISTINCTION BETWEEN ALL AND AML: morphology
Auer Rods
granules
Nucleoli
None; present
Coarse; fine
Inconspicuous; fine
ALL
Immunophenotyping by flow cytometry
B-ALL is usualy positive for ??
T-ALL is usualy positive for ???
B-ALL is usualy positive for CD10 (CALLA), CD19, and CD20
T-ALL is usualy positive for CD2-CD8, especialy CD3
AML
Immunophenotyping by flow cytometry
The majority of subtypes are positive for CD13, 33. 34, 117, and HLA-DR
ACUTE LYMPHOID LEUKAEMIA (ALL)
A malignant transformation of a clone of ___________ cells leading to a proliferation and accumulation of _________.
lymphoid stem
lymphoblasts
ALL can occur both in adult and children.
T/F
T
_______ is the most common malignancy of childhood constituting about _____% of childhood leukaemias.
ACUTE LYMPHOID LEUKAEMIA (ALL)
80
ALL - Aetiology
____________ cause or risk factors in most cases
No identifiable
ALL - Aetiology
Environmental risk factors - prior bone marrow damage due to _______, ________ and electromagnetic fields
alkylating chemotherapy
ionizing radiation
ALL - Aetiology
Adult T-cell leukemia/lymphoma is linked to infection with ______
HTLV
ALL - Aetiology
Genetic or chromosomal factors
•Down syndrome - risk of ALL is ___-___ times higher in patients with Down syndrome
•—————- type 1
•___________
10–20
Neurofibromatosis
Ataxia telangiectasia
ALL Classification
Classification may be based on
______
_________
The current ____ Classification (2016)
Morphology
Immunological markers -
WHO
ALL Classification
Classification may be based on
Morphology - the __________________ classification of ALL
French-American-British (FAB) historical
ALL Classification
Classification may be based on
Immunological markers -
Immunophenotype classification of ALL: based on the ____ (B cell or T cell) and _____ of the leukemic cells
origin
Maturity