Acute Lymphoblastic Leukaemia Flashcards

1
Q

What is acute lymphoblastic leukaemia?

A

malignancy of BM + blood characterised by the proliferation of lymphoblasts (primitive lymphoid cells)
fail to develop into mature T or B cells

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2
Q

Describe the pathophysiology of ALL

A

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

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3
Q

List 3 environmental risk factors for ALL

A

Radiation
Cigarette smoking
Exposure to chemicals

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4
Q

List 4 genetic risk factors for ALL

A

Down’s syndrome
Neurofibromatosis type 1
Fanconi’s anaemia
Xeroderma pigmentosum

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5
Q

Describe the epidemiology of ALL

A

MOST COMMON malignancy of CHILDHOOD
Peak incidence: 2-5 yrs old
(2nd peak in elderly)
Annual UK incidence: 1/70,000

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6
Q

List 3 categories of symptoms arising in ALL from bone marrow failure

A

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

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7
Q

List 4 symptoms arising in ALL from organ infiltration

A

Tender bones
Lymphadenopathy
Mediastinal compression
Meningeal involvement (headache, visual disturbances, nausea)

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8
Q

List 4 signs of bone marrow failure in ALL

A

Pallor
Bruising
Bleeding
Infection + Fever

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9
Q

List 7 signs of organ infiltration in ALL

A
Lymphadenopathy 
Hepatosplenomegaly 
CN palsies  
Retinal haemorrhage  
Papilloedema on fundoscopy  
Leukaemic infiltration of the anterior chamber of the eye  
Testicular swelling
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10
Q

What bloods are investigated in ALL?

A
FBC: normochromic normocytic anaemia, low platelets, variable WCC 
High uric acid  
High LDH 
High calcium due to bony infiltration  
Clotting screen: identify DIC
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11
Q

What is seen on blood film in ALL?

A

Abundant lymphoblasts

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12
Q

What may be seen on CXR and bone radiographs in ALL?

A

CXR: mediastinal lymphadenopathy, lytic bone lesions
Bone: mottled appearance with punched out lesions due to leukaemic infiltration

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13
Q

What is the diagnostic test for ALL?

A

Bone Marrow Aspiration + Trephine Biopsy

Hypercellular with > 20% lymphoblasts

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14
Q

What investigations may be performed on aspirate in ALL?

A

Immunophenotyping: identify specific lineage
Cytogenetic: for prognosis
Cytochemistry

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15
Q

Why perform an LP in ALL?

A

check for CNS involvement

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