Acute Lymphoblastic Leukaemia Flashcards
Define Acute Lymphoblastic Leukaemia? (ALL)
Malignancy of the bone marrow and blood characterised by the proliferation of lymphoblasts (primitive lymphoid cells)
What is the aetiology of ALL?
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
What are the risk factors for ALL?
Environmental (radiation, viruses)
Genetic (Down’s Syndrome, Neurofibromatosis type 1, Fanconi’s Anaemia, xeroderma pigmentosum)
What is the epidemiology of ALL?
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
What are the presenting symptoms of ALL?
Symptoms of Bone Marrow Failure
Symptoms of Organ Infiltration
What are the symptoms of Bone Marrow Failure?
Anaemia (fatigue, dyspnoea)
Bleeding (spontaneous bruising, bleeding gums, menorrhagia)
Opportunistic Infections
What are the symptoms of Organ Infiltration?
Tender bones
Enlarged Lymph Nodes
Mediastinal Compression
Meningeal Involvement (headache, visual disturbances, nausea)
What are the signs of ALL on physical examination?
Signs of Bone Marrow failure
Signs of Organ Infiltration
What are the signs of Bone Marrow Failure?
Pallor
Bruising
Bleeding
Infection
What are the signs of Organ Infiltration?
Lymphadenopathy Hepatosplenomegaly Cranial Nerve Palsies Retinal haemorrhage Papilloedema on fundoscopy Leukaemic infiltration of the anterior chamber of the eye Testicular Swelling
What bloods would you do for ALL and what would you see?
FBC - normochromic normocytic anaemia, low platelets, variable WCC
High Uric Acid
High LDH
Clotting Screen
What would you see on a blood film for ALL?
Abundant Lymphoblasts
What would you see in a Bone Marrow Aspirate or Trephine Biopsy in ALL?
Hypercellular with > 20% lymphoblasts
What other investigations could you do for ALL and how would they be used?
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
What would you see in a bone radiograph for ALL?
Mottled apperance with punched out lesions due to leukaemic infiltration