Acute Lymphoblastic Leukaemia

Question 1

Define:

Answer 1

Malignancy of the bone marrow and blood characterised by the proliferation of lymphoblasts

Question 2

Aetiology:

Answer 2

There is a mutation in the precursor blood cells in the bone marrow.

This can be due to a chromosomal translocation (9+22 and 12+21) or abnormal chromosomal number.

This leads to hyperproliferation and these replace normal bone marrow cells leading to bone marrow failure and infiltration into tissues

Question 3

Risk factors:

Answer 3

Environment (radiation and viruses)

Genetic (Down’s, Facconi’s and xeroderma pigementosa)

Question 4

Epidemiology:

Answer 4

Most common malignancy in children.
Peaks ages 2-5 and then in the elderly
1/70,000 per year UK incidence

Question 5

Symptoms:

Answer 5

Anaemia (fatigue and dyspnoea)
Opportunistic infections
Bleeding (spontaneous bruising, bleeding gums and menorrhagia)

Of organ infiltration:

• Mennignism (headaches, neck stiffness and photophobia)
• Tender bones
• Enlarged lymph nodes
• Mediastinal compression

Question 6

Signs:

Answer 6

Bleeding
Infection
Pallor
Bruising

Of organ infiltration:

• Hepatosplenomegaly
• Lymphadenopathy
• Cranial nerve palsises
• Papilloedema
• Testicular swelling

Question 7

Investigations:

Answer 7

FBC - low platelets, normochromic normocytic anaemia and variable WCC

High uric acid

High Lactate dehydrogenase

Clotting

Blood smear - abundant lymphoblasts

Bone marrow aspirate (hyperceullular with >20% lymphoblasts)

CXR (check for lytic lesions and lymphadenopathy)

LP (CNS involvement)

Bone radiograph