Blood Cancers Flashcards
Which white blood cells come from the common myeloid progenitor?
Basophil
Neutrophil
Eosinophil
Monocyte/macrophage
Which white blood cells come from the common lymphoid progenitor?
Natural killer cells
T cell
B cell/plasma cell
What protein is present in the urine of patients with myeloma?
Bence-Jones
What investigation is carried out to find the bence-jones protein?
Urine protein electrophoresis
What would a patient with myeloma present with?
Bone pain - typically back ache
What is the treatment for myeloma?
Incurable, relapsing/remitting disease
transplant and thalidomide
transplant candidates - thalidomide and dexamethosone
non-transplant candidates -
supportive care
What is myeloma normally associated with?
osteolytic bone disease
anaemia
renal failure
hypercalcaemia
What investigation is used to confirm multiple myeloma? (after bench-jones has been found)
skeletal survey
Simply, what is the problem caused by leukaemia?
Too many white blood cells, not enough red blood cells
so can’t fight infection
What are the symptoms of acute lymphocytic leukaemia?
easy bruising fatigue dyspnoea dizziness bleeding recurrent infections
What is ALL characterised by?
early precursor cells replacing haematopoietic cells of the bone marrow and further infiltrating other body organs
What are the key diagnostic features of ALL?
presence of risk factors
lymphadenopathy
hepatosplenomegaly
pallor, ecchymoses, or petechiae
What are the risk factors of ALL?
<6 years old - most common blood cancer in kids
mid to late 30s
mid 80s
What is the diagnostic approach for ALL?
bone marrow biopsy/peripheral blood smear - hypercellularity and infiltration by leukaemic lymphoblasts (at least 20% for definitive diagnosis)
other tests: FBC with differential peripheral blood smear serum electrolytes LFT U&E coagulation profile
What is the treatment of ALL?
combination chemotherapy - prednisone - vincristine - anthracyclines etc.
stem cell transplant
What is the definition of chronic lymphocytic leukaemia?
Indolent lymphoproliferative disorder in which monoclonal B lymphocytes are predominantly found in peripheral blood
What is the disorder called when monoclonal B lymphocytes are found in the lymph nodes?
small lymphocytic lymphoma
What are the key diagnostic factors of CLL?
shortness of breath and fatigue
lymphadenopathy
splenomegaly
presence of risk factors
risk factors for CLL
age >60
What is the first step in CLL diagnosis?
FBC with differential - shows an absolute clonal lymphocytosis
What is the rai staging system of CLL?
0 - lymphocytosis 1 - lymphadenothay and lymphocytosis 2 - lymphadenopathy and spleno/hepatomegaly 3 - lymphocytosis and anaemia 4 - lymphocytosis and thrombocytopaenia
Management of CLL?
initially (assymptomatic) don’t require treatment - just observation
advanced - chemoimmunotherapy or ibrutinib
What is the definition of acute myelogenous leukaemia?
life threatening disorder than commonly occurs in older adults
clonal expansion of myeloid blasts in the bone marrow, peripheral blood, or extramedullary tissues.
What is diagnostic for AML?
> 20% myeloid bone marrow blasts
or
the presence of specific clonal cytogenetic abnormalities
What are the key diagnostic features for AML?
pallor
ecchymoses or petechiae
What are the risk factors of AML?
previous chemo age >65 previous haematological dyspoiesis genetic factors benzene exposure radiation exposure constitutional karyotype abnormalities
Investigations for AML?
FBC with differential - anaemia, macrocytosis, leukocytosis, neutropenia, thrombocytopenia
peripheral blood smear - blasts on film and Bauer rods
coagulation panel
baseline -
serum electrolytes
U&E, LFT
serum lactate dehydrogenase
Treatment for AML?
intensive chemotherapy
- cytarabine
plus others
What are the risk factors for chronic myeloid leukaemia?
middle aged - 40-60
Investigations for CML?
FBC - elevated WBC, anaemia, normal platelet, thrombocytosis (chronic or accelerated phases), or thrombocytopenia (accelerated or blast crisis)
metabolic profile - elevated potassium, LDH, or uric acid
bone marrow biopsy - for cytogenetics - Philadelphia chromosome
peripheral blood smear - used for monitoring - peripheral blood basophils >20%
Management of CML?
imatinib
