Anaemia and Leukaemia

Question 1

which cells do myeloid stem cells produce ?

Answer 1

red blood cells, platelets, myeloblasts (granulocytes and agranulocytes)

Question 2

which cells do lymphoid stem cells produce ?

Answer 2

lymphoblasts

Question 3

what is the definition of anaemia ?

Answer 3

a reduction in one or more of the major red blood cell measurements obtained as part of a full blood count

Question 4

what are the special consideration for diagnosing anaemia ?

Answer 4

acute bleed - drop in Hb or heamatocrit may not be shown until 36-48 hrs after an acute bleed.
pregnancy - in third trimester plasma volume is expanded by 50 %, reductions in Hb and Hct but actually polycythemic according to RBC mass.
volume depletion - may not show anaemia until rehydrated

Question 5

what are the neurological symptoms of anaemia ?

Answer 5

dizziness, fainting, lack of concentration, blurred vision, pareasthesia, insomnia, irritability, depression

Question 6

what are the cardiovascular symptoms of anaemia ?

Answer 6

chest pain, shortness of breath, palpitations, intermittent claudication, heart failure

Question 7

what are the musculoskeletal symptoms of anaemia ?

Answer 7

fatigue, tiredness, cramps

Question 8

what are the signs of anaemia ?

Answer 8

pallor, tachycardia, postural hypotension, cardiac failure, systolic flow murmor, confusion

Question 9

what is a sign of ferritin deficiency anaemia ?

Answer 9

koilonychia (spoon shaped nails)

Question 10

what is a sign of haemolytic anaemia ?

Answer 10

jaundice

Question 11

what is a sign of sickle cell anaemia ?

Answer 11

leg ulcers

Question 12

what is a sign of thalassemia major ?

Answer 12

bone deformities

Question 13

what are the oral signs of anaemia ?

Answer 13

atrophic glossitis, pseudomembranous candidosis, ulcers, angular cheilitis

Question 14

how is anaemia classified ?

Answer 14

microcytic, normocytic, macrocytic

Question 15

what types of anaemia are microcytic ?

Answer 15

ferritin deficiency, thalaessemia, anaemia of chronic disorder, sideroblastic anaemia

Question 16

what types of anaemia are normocytic ?

Answer 16

heamorrhage, haemolytic anaemia, anaemia of chronic disorder, bone marrow fracture

Question 17

what types of anaemia are macrocytic ?

Answer 17

megaloblastic - vit B12 deficiency, folate deficiency.

non megaloblastic - alcohol, liver disease, folate deficiency, hypothyroidism, myeloidysplasia, aplastic anaemia

Question 18

what are the causes of ferritin deficiency anaemia ?

Answer 18

poor dietary intake of iron, reduced iron absorption (gastritis, coeliac), increased physiological demands (puberty, pregnancy, infancy), increased blood loss

Question 19

what are the additional clinical manifestations of ferritin deficiency anaemia ?

Answer 19

pica and pagophagia (craving ice), beeturia, restless legs syndrome

Question 20

what is the treatment for ferritin deficiency ?

Answer 20

treat underlying cause, oral iron supplementation, iv infusion

Question 21

where is vitamin B12 absorbed and what cofactor is required for absorption ?

Answer 21

terminal ileum and intrinsic factor

Question 22

what are the cause of vit B12 deficiency ?

Answer 22

pernicious anaemia, gastrectomy, malabsorption, inadequate intake, nitrous oxide anaesthesia

Question 23

what clinical features are seen in B12 deficiency ?

Answer 23

premature greying of hair, jaundice, skin pigmentation, neuropathy due to build up of homocysiene

Question 24

what is the treatment for vitamin B12 deficiency ?

Answer 24

1mg hydroxycobalamin IM injections

Question 25

what are the causes of folate deficiency ?

Answer 25

diet, alcohol, folic acid antagonists e.g. methorexate, malabsorption

Question 26

what is the treatment for folate deficiency ?

Answer 26

5mg PO folic acid daily for 4 months

Question 27

what is the definition of leukaemia ?

Answer 27

a malignant condition of blood arising when there is a clonal proliferation of malignant blood cells derived from a primitive haemopoietic stem cell in the bone marrow

Question 28

where does malignant transformation occur in acute leukaemia ?

Answer 28

haemopoietic stem cell/early progenitor cell

Question 29

where does the malignant transformation occur in chronic leukaemia ?

Answer 29

mature precursor cells

Question 30

what are the inherited risk factors for leukaemia ?

Answer 30

downs syndrome, klinefelters syndrome, wiskott-aldrich syndrome, hereditary immuno deficiencies

Question 31

what are the environmental risk factors for leukaemia ?

Answer 31

radiation, chemotherapy, benzene, infection, myeloidysplasia, myeloproliferative disease

Question 32

what is the most common acute leukaemia in adults ?

Answer 32

acute myeloid leukaemia (AML)

Question 33

what are the clinical features of AML ?

Answer 33

bone marrow failure - anaemia, neutropenia (infection, fever), thrombocytopenia (bruising, bleeding gums). organ infiltration - lymphadenopathy, hepatomegaly, splenomegaly, bone pain, meningism, gingival hypertrophy

Question 34

what investigations are used to diagnose AML ?

Answer 34

``` FBC - WCC significantly raised, anaemia, thrombocytopenia. blood film - blast cells. BM biopsy - >20% blasts. flow cytometry. cytogenics ```

Question 35

what is the treatment for AML ?

Answer 35

combination chemotherapy, central venous catheter for antimicrobial therapy, RBC and platelet transfusions, bone marrow transplant

Question 36

what is does the prognosis for AML depend on ?

Answer 36

age and cytogenic profile

Question 37

what is the most common leukaemia in children ?

Answer 37

acute lymphoblastic leukaemia ALL

Question 38

what are the clinical features of ALL ?

Answer 38

similar to AML but more frequently lymphadenopathy, splenomegaly and CNS involvement

Question 39

what investigation is used to look for meningeal disease in AML ?

Answer 39

lumbar puncture

Question 40

what is the treatment for ALL ?

Answer 40

combination chemotherapy with intrathecal prophylaxis, BM transplant in adults

Question 41

which leukaemia is a disease elusive to adults ?

Answer 41

chronic myeloid leukaemia CML

Question 42

what is CML ?

Answer 42

a clonal expansion myeloproliferative disorder characterised by an increase in mature myelocytes esp neutrophils

Question 43

which chromosome characterises CML ?

Answer 43

Philadelphia chromosome

Question 44

what are the phases of CML ?

Answer 44

chronic phase, accelerated phase, blast transformation (evolution to AML)

Question 45

what are the clinical features of CML ?

Answer 45

anaemia, thrombocytopenia, slplenomegaly, hypermetabolism (anorexia, night sweats), hyper viscosity (visual disturbances, deafness, headache), lymphadenopathy and hepatomegaly

Question 46

which cells are increased in CML ?

Answer 46

myeloblasts esp neutrophils

Question 47

what is the treatment for CML ?

Answer 47

tyrosine kinase inhibitor Glivec chemotherapy, splenectomy for comfort, BM transplant

Question 48

what is the most common type of leukaemia ?

Answer 48

chronic lymphocytic leukaemia CLL

Question 49

what is CLL ?

Answer 49

clonal lymphoproliferative disease in which mostly B lymphocytes accumulate in the blood, BM and spleen as a result of increased life expectancy and reduced apoptosis. most cases are asymptomatic

Question 50

what are the symptoms of CLL if any ?

Answer 50

lymphadenopathy, splenomegaly and hepatomegaly, immunosuppression

Question 51

what investigations are used to diagnose CLL ?

Answer 51

FBC - increased white cells, anaemia blood film - lots of lymphocytes, smudge and smear cells BM biopsy - heavy lymphocyte infiltration replacing normal BM elements

Question 52

what is the treatment for CLL ?

Answer 52

chemotherapy - oral chlorambucil +/- CHOP

Question 53

what is the prognosis of CLL ?

Answer 53

normal life expectancy if asymptomatic at presentation, prognosis deteriorates if signs of organ infiltration

Question 54

what are the presentations of leukaemia in the oral cavity ?

Answer 54

gingival hyperplasia, mucosal leukaemic deposits, infection