Acute Lymphoblastic Leukaemia Flashcards
What is ALL?
Malignancy of lymphoid cells that affect B or T cell lineages
What are important associations of ALL?
Ionising radiation, Down’s syndrome
What is the commonest cancer of childhood?
ALL
How does ALL cause problems?
Arresting maturation, promotes uncontrolled proliferation of immature blast cells, marrow failure, tissue infiltration
What are signs and symptoms due to?
Marrow failure and infiltration
What signs and symptoms are due to marrow failure and what type of blood cell are they due to?
Anaemia - RBC, Infections - WCC, Bleeding - Platelets
What signs and symptoms are due to infiltration?
Hepatomegaly, Splenomegaly, Lymphadenopathy, CNS involvement, SVC obstruction
What investigations would you do?
FBC, Blood film, Lumbar puncture, CXR/CT
In which test would you find characteristic blast cells?
Blood film
What is the purpose of a CXR/CT scan?
To look for lymphadenopathy
What is the purpose of a lumbar puncture?
To look for CNS involvement
What management would you start?
Blood and platelet transfusions, chemo, steroids, intrathecal drugs, stem cell transplant
How would you treat infections?
IV antibiotics
What is morphological classification?
Classification based on microscopic appearance
What does L1 look like?
Small blasts with scanty cytoplasm
What does L2 look like?
Larger blast cells with greater morphological variation and more abundant cytoplasm
What does L3 look like?
Blasts with vacuolated basophilic cytoplasm
What is immunological classification?
Classification based on surface markers. Separates in precursor B cell, T cell and B cell
What is cytogenetic classification?
Classification based on chromosomal analysis
What drug would you start to prevent tumour lysis syndrome?
Allopurinol
Give an example of an intrathecal drug
Methotrexate
