Anaemia and Leukaemia Flashcards
which cells do myeloid stem cells produce ?
red blood cells, platelets, myeloblasts (granulocytes and agranulocytes)
which cells do lymphoid stem cells produce ?
lymphoblasts
what is the definition of anaemia ?
a reduction in one or more of the major red blood cell measurements obtained as part of a full blood count
what are the special consideration for diagnosing anaemia ?
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
what are the neurological symptoms of anaemia ?
dizziness, fainting, lack of concentration, blurred vision, pareasthesia, insomnia, irritability, depression
what are the cardiovascular symptoms of anaemia ?
chest pain, shortness of breath, palpitations, intermittent claudication, heart failure
what are the musculoskeletal symptoms of anaemia ?
fatigue, tiredness, cramps
what are the signs of anaemia ?
pallor, tachycardia, postural hypotension, cardiac failure, systolic flow murmor, confusion
what is a sign of ferritin deficiency anaemia ?
koilonychia (spoon shaped nails)
what is a sign of haemolytic anaemia ?
jaundice
what is a sign of sickle cell anaemia ?
leg ulcers
what is a sign of thalassemia major ?
bone deformities
what are the oral signs of anaemia ?
atrophic glossitis, pseudomembranous candidosis, ulcers, angular cheilitis
how is anaemia classified ?
microcytic, normocytic, macrocytic
what types of anaemia are microcytic ?
ferritin deficiency, thalaessemia, anaemia of chronic disorder, sideroblastic anaemia
what types of anaemia are normocytic ?
heamorrhage, haemolytic anaemia, anaemia of chronic disorder, bone marrow fracture
what types of anaemia are macrocytic ?
megaloblastic - vit B12 deficiency, folate deficiency.
non megaloblastic - alcohol, liver disease, folate deficiency, hypothyroidism, myeloidysplasia, aplastic anaemia
what are the causes of ferritin deficiency anaemia ?
poor dietary intake of iron, reduced iron absorption (gastritis, coeliac), increased physiological demands (puberty, pregnancy, infancy), increased blood loss
what are the additional clinical manifestations of ferritin deficiency anaemia ?
pica and pagophagia (craving ice), beeturia, restless legs syndrome
what is the treatment for ferritin deficiency ?
treat underlying cause, oral iron supplementation, iv infusion
where is vitamin B12 absorbed and what cofactor is required for absorption ?
terminal ileum and intrinsic factor
what are the cause of vit B12 deficiency ?
pernicious anaemia, gastrectomy, malabsorption, inadequate intake, nitrous oxide anaesthesia
what clinical features are seen in B12 deficiency ?
premature greying of hair, jaundice, skin pigmentation, neuropathy due to build up of homocysiene
what is the treatment for vitamin B12 deficiency ?
1mg hydroxycobalamin IM injections
what are the causes of folate deficiency ?
diet, alcohol, folic acid antagonists e.g. methorexate, malabsorption
what is the treatment for folate deficiency ?
5mg PO folic acid daily for 4 months
what is the definition of leukaemia ?
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
where does malignant transformation occur in acute leukaemia ?
haemopoietic stem cell/early progenitor cell
where does the malignant transformation occur in chronic leukaemia ?
mature precursor cells
what are the inherited risk factors for leukaemia ?
downs syndrome, klinefelters syndrome, wiskott-aldrich syndrome, hereditary immuno deficiencies
what are the environmental risk factors for leukaemia ?
radiation, chemotherapy, benzene, infection, myeloidysplasia, myeloproliferative disease
what is the most common acute leukaemia in adults ?
acute myeloid leukaemia (AML)
what are the clinical features of AML ?
bone marrow failure - anaemia, neutropenia (infection, fever), thrombocytopenia (bruising, bleeding gums).
organ infiltration - lymphadenopathy, hepatomegaly, splenomegaly, bone pain, meningism, gingival hypertrophy
what investigations are used to diagnose AML ?
FBC - WCC significantly raised, anaemia, thrombocytopenia. blood film - blast cells. BM biopsy - >20% blasts. flow cytometry. cytogenics
what is the treatment for AML ?
combination chemotherapy, central venous catheter for antimicrobial therapy, RBC and platelet transfusions, bone marrow transplant
what is does the prognosis for AML depend on ?
age and cytogenic profile
what is the most common leukaemia in children ?
acute lymphoblastic leukaemia ALL
what are the clinical features of ALL ?
similar to AML but more frequently lymphadenopathy, splenomegaly and CNS involvement
what investigation is used to look for meningeal disease in AML ?
lumbar puncture
what is the treatment for ALL ?
combination chemotherapy with intrathecal prophylaxis, BM transplant in adults
which leukaemia is a disease elusive to adults ?
chronic myeloid leukaemia CML
what is CML ?
a clonal expansion myeloproliferative disorder characterised by an increase in mature myelocytes esp neutrophils
which chromosome characterises CML ?
Philadelphia chromosome
what are the phases of CML ?
chronic phase, accelerated phase, blast transformation (evolution to AML)
what are the clinical features of CML ?
anaemia, thrombocytopenia, slplenomegaly, hypermetabolism (anorexia, night sweats), hyper viscosity (visual disturbances, deafness, headache), lymphadenopathy and hepatomegaly
which cells are increased in CML ?
myeloblasts esp neutrophils
what is the treatment for CML ?
tyrosine kinase inhibitor Glivec chemotherapy, splenectomy for comfort, BM transplant
what is the most common type of leukaemia ?
chronic lymphocytic leukaemia CLL
what is CLL ?
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
what are the symptoms of CLL if any ?
lymphadenopathy, splenomegaly and hepatomegaly, immunosuppression
what investigations are used to diagnose CLL ?
FBC - increased white cells, anaemia
blood film - lots of lymphocytes, smudge and smear cells
BM biopsy - heavy lymphocyte infiltration replacing normal BM elements
what is the treatment for CLL ?
chemotherapy - oral chlorambucil +/- CHOP
what is the prognosis of CLL ?
normal life expectancy if asymptomatic at presentation, prognosis deteriorates if signs of organ infiltration
what are the presentations of leukaemia in the oral cavity ?
gingival hyperplasia, mucosal leukaemic deposits, infection
