Acute Lymphoblastic Leukaemia Flashcards

1
Q

Define Acute Lymphoblastic Leukaemia? (ALL)

A

Malignancy of the bone marrow and blood characterised by the proliferation of lymphoblasts (primitive lymphoid cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the aetiology of ALL?

A

Lymphoblasts undergo malignancy transformation and proliferation
This leads to the replacement of normal bone marrow elements, leading to bone marrow failure and infiltration into other tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for ALL?

A

Environmental (radiation, viruses)

Genetic (Down’s Syndrome, Neurofibromatosis type 1, Fanconi’s Anaemia, xeroderma pigmentosum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the epidemiology of ALL?

A

Most common malignancy of childhood
Peak Indidence: 2-5 years old
There is a second peak in incidence in the elderly
Annual UK incidence: 1/70,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the presenting symptoms of ALL?

A

Symptoms of Bone Marrow Failure

Symptoms of Organ Infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of Bone Marrow Failure?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the symptoms of Organ Infiltration?

A

Tender bones
Enlarged Lymph Nodes
Mediastinal Compression
Meningeal Involvement (headache, visual disturbances, nausea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs of ALL on physical examination?

A

Signs of Bone Marrow failure

Signs of Organ Infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the signs of Bone Marrow Failure?

A

Pallor
Bruising
Bleeding
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the signs of Organ Infiltration?

A
Lymphadenopathy
Hepatosplenomegaly 
Cranial Nerve Palsies 
Retinal haemorrhage 
Papilloedema on fundoscopy 
Leukaemic infiltration of the anterior chamber of the eye 
Testicular Swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What bloods would you do for ALL and what would you see?

A

FBC - normochromic normocytic anaemia, low platelets, variable WCC
High Uric Acid
High LDH
Clotting Screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What would you see on a blood film for ALL?

A

Abundant Lymphoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What would you see in a Bone Marrow Aspirate or Trephine Biopsy in ALL?

A

Hypercellular with > 20% lymphoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What other investigations could you do for ALL and how would they be used?

A

Immunophenotyping - using antibodies to recognise cell surface antigens
Cytogenic - karyotyping to look for chromosomal abnormalities or translocations
Cytochemistry
Lumbar Puncture - check for CNS involvement
CXR- may show mediastinal lymphadenopathy, lytic bone lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What would you see in a bone radiograph for ALL?

A

Mottled apperance with punched out lesions due to leukaemic infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly