Acute Lymphoblastic Leukaemia Flashcards
What is acute lymphoblastic leukaemia?
https://www.youtube.com/watch?v=itkRVTqfPsE
Malignancy of lymphoid cells, affecting T or B cell lines, arresting maturation and promoting uncontrolled proliferation of immature blast cells, with marrow failure and tissue infiltration
What are known causes of ALL?
Precise cause unknown
- Prenatal Ionizing radiation
- In utero exposure to infection
- Environmental radiation
- Down’s Syndrome
Who does ALL most commonly affect?
Children - rare in adults
What proportion of ALL are of B-cell lineage?
75-90%
How does ALL present?
- Fatigue
- Anorexia
- Fever
- Bone pain
- Painless lumps - Neck, axilla, groin
- Marrow failure - Pallor (anaemia), Infection, Bleeding
- Infiltration - Hepatosplenomegaly, lymphadenopathy, orchidomegaly, CNS involvement
What are signs of thrombocytopenic bleeding?
- Petechiae/Purpura
- Mucosal bleeding - gums
- Fundal haemorrhage
What are the commonest infections that occur in ALL?
Chest, mouth, perianal, skin
- Bacterial septicaemia
- Herpes Zoster
- CMV
- Measles
- Candidiasis
- Pneumocystis Pneumonia
What are the following?
Petechiae - Small (1–2 mm) haemorrhages into mucosal or serosal surfaces
What are causes of the following?
- Thrombocytopenia of any cause - autoimmune, heparin-induced, hypersplenism
- Bone marrow failure - malignancy
- Defective platelet function
- DIC
- Infection
- Bone marrow defects
- Factor deficiencies
What is the following?
Purpura - >3 mm haemorrhages, or when ecchymoses and petechiae form in groups
What are causes of the following?
Diseases associated with:
- Trauma
- Vasculitis – particularly palpable purpura
- Amyloidosis
- Over-anticoagulation
- Factor deficiencies
What is the mechanism of colour change in bruising?
Erythrocyte -> Bilirubin (blue/green) -> Haemosiderin (yellow)
Once under the skin, erythrocytes are phagocytosed and degraded by macrophages, with haemoglobin converted to bilirubin (blue–green discolouration).
Bilirubin is eventually broken down into haemosiderin (which is golden brown) at the end of the process before skin returns to its normal hue.
What CNS involvement can occur in ALL?
- Cranial nerve palsies
- Meningism
What are poor prognostic factors for ALL?
- Age > 60yrs - “dreadful”
- White cell count > 300 x 109/L
- Immunophenotype (more primitive forms)
- Cytogenetics/molecular genetics - Philedelphia chromosome t(9;22); t(4;11)
- Slow/poor response to treatment
- Presentation with CNS signs
How would you investigate suspected ALL?
- Bedside - examination
- Bloods - FBC, U+E’s, LFTS, LDH, Urate, Coagulation screen, Blood film
- O
- X - CXR, CT Scan
- ECG - no
- Specific - Bone marrow, Consider LP