Acute Lymphoblastic Leukaemia Flashcards
What is acute lymphoblastic leukaemia?
malignancy of BM + blood characterised by the proliferation of lymphoblasts (primitive lymphoid cells)
fail to develop into mature T or B cells
Describe the pathophysiology of ALL
Lymphoblasts undergo malignancy transformation + proliferation
This leads to the replacement of normal marrow elements, leading to BM failure + infiltration into other tissues
List 3 environmental risk factors for ALL
Radiation
Cigarette smoking
Exposure to chemicals
List 4 genetic risk factors for ALL
Down’s syndrome
Neurofibromatosis type 1
Fanconi’s anaemia
Xeroderma pigmentosum
Describe the epidemiology of ALL
MOST COMMON malignancy of CHILDHOOD
Peak incidence: 2-5 yrs old
(2nd peak in elderly)
Annual UK incidence: 1/70,000
List 3 categories of symptoms arising in ALL from bone marrow failure
Anaemia (fatigue, dyspnoea)
Bleeding (spontaneous bruising, bleeding gums, menorrhagia)
Opportunistic infections
List 4 symptoms arising in ALL from organ infiltration
Tender bones
Lymphadenopathy
Mediastinal compression
Meningeal involvement (headache, visual disturbances, nausea)
List 4 signs of bone marrow failure in ALL
Pallor
Bruising
Bleeding
Infection + Fever
List 7 signs of organ infiltration in ALL
Lymphadenopathy Hepatosplenomegaly CN palsies Retinal haemorrhage Papilloedema on fundoscopy Leukaemic infiltration of the anterior chamber of the eye Testicular swelling
What bloods are investigated in ALL?
FBC: normochromic normocytic anaemia, low platelets, variable WCC High uric acid High LDH High calcium due to bony infiltration Clotting screen: identify DIC
What is seen on blood film in ALL?
Abundant lymphoblasts
What may be seen on CXR and bone radiographs in ALL?
CXR: mediastinal lymphadenopathy, lytic bone lesions
Bone: mottled appearance with punched out lesions due to leukaemic infiltration
What is the diagnostic test for ALL?
Bone Marrow Aspiration + Trephine Biopsy
Hypercellular with > 20% lymphoblasts
What investigations may be performed on aspirate in ALL?
Immunophenotyping: identify specific lineage
Cytogenetic: for prognosis
Cytochemistry
Why perform an LP in ALL?
check for CNS involvement