Acute Lymphoblastic Anaemia Flashcards
1
Q
What is Leukaemia?
A
- Leukaemia refers to a group of malignancies that arise in the bone marrow
2
Q
How common is Acute lymphoblastic leukaemia?
A
- most common malignancy in children
3
Q
How does acute lymphoblastic leukaemia arise?
A
- ALL arises from a clone of lymphoid progenitor cells that undergo malignant transformation
- Most are B cell in origin
- As clonal expansion occurs lymphoid precursors replace other haematopoietic cells in the bone marrow
4
Q
What is the peak age for ALL ? What gender is more commonly affected?
A
It is the most common under 5s. More common in males
5
Q
What are the risk factors for ALL?
A
- Genetic Conditions
- Previous treatment with chemotherapy (etoposide, thiotepa, busulfan)
- Ionising Radiation Exposure (atomic bomb exposure, Chernobyl nuclear power plant, CT scan and Radiotherapy)
- Exposure to Benzene (petrol industry, chemical industry, rubber industry and shoe production)
- Weakened immune system
6
Q
Where can leukaemia spread to?
A
- lymph nodes
- liver
- spleen
- CNS
- testicles
7
Q
Which cells are affected in ALL?
A
- B lymphocytes
- T lymphocytes
8
Q
What are the types of ALL?
A
- B-cell Acute lymphoblastic leukaemia ( precursor B cell ALL, mature B cell ALL, Common ALL, Pro B cell ALL)
- T cell Acute lymphoblastic leukaemia
- Philadelphia Positive ALL
9
Q
What happens in Philadelphia positive ALL?
A
- There is a change in the chromosome of the leukaemia cells
- The ABL1 gene on chromosome 9 breaks off and sticks to the BCR gene on chromosome 22
- This produces a BCR-ABL1 gene which causes the cell to make too much of the protein tyrosine kinase
- This protein causes leukaemia to grow and multiply
10
Q
How is Philadelphia positive ALL treated?
A
- Imatinib
11
Q
How and why does leukaemia affect you?
A
- Many abnormal WCC are produced, hence you are more likely to get infections and may find it more difficult to get rid of them
- Lower amount of RCC and platelets due to the overcrowding of the WCC
- Low RCC causes anaemia leaving you feeling tired and breathless
- Low Platelets Leads to bleeding problems such as nosebleeds
12
Q
What are the symptoms of ALL?
A
- General Weakness
- Feeling Tired
- High Temperature
- Frequent Infections
- Bruising/ Bleeding easily (nosebleeds, heavy periods, bleeding gums, blood in urine/stool)
- Weight Loss
- Swollen Lymph Nodes
- Feeling SOB
- Feeling Full in tummy
- Pain in bones or joints
- Pale skin
13
Q
Which symptoms of T cell ALL can be life threatening?
A
- Swollen lymph nodes in the centre of your chest OR thymus gland is bigger in the upper chest.
- This presses on the windpipe causing breathlessness and coughing
- Pressure on the vessels going to the head causing SVCO
14
Q
What blood tests would you want to investigate for ALL? What would you see on a blood film?
A
- FBC ( anaemia, thrombocytopenia, leucocytosis with neutropenia)
- U+E ( Hypercalcaemia due to release of PTH-like hormone)
- LFTs
- Clotting and D-Dimer ( risk of DIC)
- Uric Acid and LDH (non specific markers of tumour burden
- BLOOD FILM = BLAST CELLS
- Blood Borne Virus Screen (HIV, HBV, HCV, EBV, CMV)
15
Q
What Imaging would be done?
A
- CXR ( would show mediastinal mass)
- CT CAP ( lymphadenopathy and organ involvement)
- CT/ MRI head (patients with symptoms indicative of neurological involvement)
