Acute Lymphoblastic leukaemia Flashcards
What is the pathophysiology of ALL?
- Stem cell –> Lymphoblast –> B cell & T cell
- Lymphoblasts multiply uncontrollably in the bone marrow
- Outgrows nutritional supply for other cell lineages resulting in cytopenias;
- Anaemia : reduction in healthy red blood cells
- Thrombocytopenia : reduction in healthy platelets
- Leukopenia : reduction in healthy white blood cells
What is the peak incidence age of ALL?
- 2 -5 years
2. Boys are more commonly affected
Name the three major cytopenias which are a consequence of ALL?
- Leukopenia
2, Thrombocytopenia - Anaemia
Name two symptoms of anaemia?
- Lethargy
2. Pallor
Name one symptoms of neutropenia?
Frequent / Severe infections
Name one symptoms of thrombocytopenia?
Easy bruising
Name two features a child with ALL may present with?
- Fever (presenting as infection or constituional feature)
2. Bone pain ( Child may refuse to walk, prefer to be carried )
Name two finding which may be found on examination?
- Heptomegaly
2. Splenomegaly
Name 3 investigations which must be carried out in a child suspected of ALL and justify them
- Full blood count - abnormal blood count with low haemoglobin and thrombocytopenia
- Bone marrow examination - Leukaemic blast cell found on bone marrow smear.
- Chest X ray - identify mediastinal mass characteristic of T cell disease
Management of ALL
Chemotherapy
How is ALL diagnosed?
Confirmed by the presence of lymphoblasts in blood film along with the findings assco with anemia and thrombocytopenia
Name the 3 phases of chemotherapy?
- Induction phase
- Consolidation phase
- Maintainance phase
What happens in the Induction phase?
Bone marrow remission - no more lymphoblast cells in blood film or bone marrow thus normal blood count can be restored as lymphoblasts are not diving rapidly.
What happens in the consolidation phase?
Lasts for several months - aims to eliminate all remaining lymphoblast cells
What happens in the maintainance phase?
Lasts up to 3 years to prevent recurrence after remission
