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Human Disease Y3 > Anaemia and Leukaemia > Flashcards

Anaemia and Leukaemia Flashcards

1
Q

which cells do myeloid stem cells produce ?

A

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

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2
Q

which cells do lymphoid stem cells produce ?

A

lymphoblasts

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3
Q

what is the definition of anaemia ?

A

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

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4
Q

what are the special consideration for diagnosing anaemia ?

A

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

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5
Q

what are the neurological symptoms of anaemia ?

A

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

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6
Q

what are the cardiovascular symptoms of anaemia ?

A

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

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7
Q

what are the musculoskeletal symptoms of anaemia ?

A

fatigue, tiredness, cramps

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8
Q

what are the signs of anaemia ?

A

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

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9
Q

what is a sign of ferritin deficiency anaemia ?

A

koilonychia (spoon shaped nails)

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10
Q

what is a sign of haemolytic anaemia ?

A

jaundice

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11
Q

what is a sign of sickle cell anaemia ?

A

leg ulcers

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12
Q

what is a sign of thalassemia major ?

A

bone deformities

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13
Q

what are the oral signs of anaemia ?

A

atrophic glossitis, pseudomembranous candidosis, ulcers, angular cheilitis

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14
Q

how is anaemia classified ?

A

microcytic, normocytic, macrocytic

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15
Q

what types of anaemia are microcytic ?

A

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

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16
Q

what types of anaemia are normocytic ?

A

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

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17
Q

what types of anaemia are macrocytic ?

A

megaloblastic - vit B12 deficiency, folate deficiency.

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

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18
Q

what are the causes of ferritin deficiency anaemia ?

A

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

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19
Q

what are the additional clinical manifestations of ferritin deficiency anaemia ?

A

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

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20
Q

what is the treatment for ferritin deficiency ?

A

treat underlying cause, oral iron supplementation, iv infusion

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21
Q

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

A

terminal ileum and intrinsic factor

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22
Q

what are the cause of vit B12 deficiency ?

A

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

23
Q

what clinical features are seen in B12 deficiency ?

A

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

24
Q

what is the treatment for vitamin B12 deficiency ?

A

1mg hydroxycobalamin IM injections

25
Q

what are the causes of folate deficiency ?

A

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

26
Q

what is the treatment for folate deficiency ?

A

5mg PO folic acid daily for 4 months

27
Q

what is the definition of leukaemia ?

A

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

28
Q

where does malignant transformation occur in acute leukaemia ?

A

haemopoietic stem cell/early progenitor cell

29
Q

where does the malignant transformation occur in chronic leukaemia ?

A

mature precursor cells

30
Q

what are the inherited risk factors for leukaemia ?

A

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

31
Q

what are the environmental risk factors for leukaemia ?

A

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

32
Q

what is the most common acute leukaemia in adults ?

A

acute myeloid leukaemia (AML)

33
Q

what are the clinical features of AML ?

A

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

34
Q

what investigations are used to diagnose AML ?

A 
FBC - WCC significantly raised, anaemia, thrombocytopenia. 
blood film - blast cells.
BM biopsy - >20% blasts. 
flow cytometry.
cytogenics
35
Q

what is the treatment for AML ?

A

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

36
Q

what is does the prognosis for AML depend on ?

A

age and cytogenic profile

37
Q

what is the most common leukaemia in children ?

A

acute lymphoblastic leukaemia ALL

38
Q

what are the clinical features of ALL ?

A

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

39
Q

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

A

lumbar puncture

40
Q

what is the treatment for ALL ?

A

combination chemotherapy with intrathecal prophylaxis, BM transplant in adults

41
Q

which leukaemia is a disease elusive to adults ?

A

chronic myeloid leukaemia CML

42
Q

what is CML ?

A

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

43
Q

which chromosome characterises CML ?

A

Philadelphia chromosome

44
Q

what are the phases of CML ?

A

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

45
Q

what are the clinical features of CML ?

A

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

46
Q

which cells are increased in CML ?

A

myeloblasts esp neutrophils

47
Q

what is the treatment for CML ?

A

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

48
Q

what is the most common type of leukaemia ?

A

chronic lymphocytic leukaemia CLL

49
Q

what is CLL ?

A

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

50
Q

what are the symptoms of CLL if any ?

A

lymphadenopathy, splenomegaly and hepatomegaly, immunosuppression

51
Q

what investigations are used to diagnose CLL ?

A

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

52
Q

what is the treatment for CLL ?

A

chemotherapy - oral chlorambucil +/- CHOP

53
Q

what is the prognosis of CLL ?

A

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

54
Q

what are the presentations of leukaemia in the oral cavity ?

A

gingival hyperplasia, mucosal leukaemic deposits, infection

Human Disease Y3 (24 decks)

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