Blood cancers Flashcards
What is myeloma?
malignant proliferation of B lymphocytic plasma cells
What are the symptoms of myeloma?
bone pain, tired, night sweats, stones
paraprotein production = renal failure and raised calcium
recurrent infections
bruising easily
How would you manage myeloma?
analgesia, chemo (VAD), bisphosphonates
blood transfusions
antibiotics
stem cell transplant
What are the two types of lymphoma?
Hodgkin’s - Reed-Steinberg cell (from B lymphocytes)
Non-Hodgkin’s - no Reed-Steinberg cells, B or T cells (slow growing but incurable)
What are the symptoms of lymphoma?
enlarged lymph nodes, compression syndromes, systemic B symptoms (weight loss, night sweats)
How would you treat lymphoma?
Hodgkin’s - AVBD chemo and radio, stem cell transplant
Non- H - anti-CD20 on B cells, ritiximab
What is lymphoma?
malignant growth of WBC, especially in the lymph nodes
What is leukemia?
bone marrow produces increased numbers of immature or abnormal WBC
What are the 4 types of leukemia?
Acute Myeloid (basophils, eosinophils, neutrophils, monocytes) Acute Lymphoblastic (B and T) Acute > 20% blasts, rapidly unwell Chronic myeloid (accumulation of myeloid cells) Chronic lymphoblastic (most common)
What are the symptoms of leukemia?
anaemia, flu-like, bleeding and bruising due to decreased platelets, enlarged spleen, enlarged lymph nodes
How would you treat leukemia?
Induction - aims to remove 99% of leukamic cells and restore bone marrow function
Consolidation - lower intensity treatment aimed at removing 1%
Maintence - background therapy for 2-3 years to maintain remission
Chemo, bone marrow transplant, antimicrobials, clinical trials
What cell is diagnostic of Hodgkin’s lymphoma?
binucleated Reed-Sternberg cell
What are some B symptoms of lymphoma?
How common are they?
Weight loss (>10% in 6 months), loss of appetite, night sweats, fever (>38), fatigue, itching, alcohol induced pain in lymph nodes 25% of cases
What are the lymph node symptoms of lymphoma?
painless on palpation, rubbery texture, typically cervical
What are some risk factors for lymphoma?
peaks in incidence in teens and elderly
family history, EBV, SLE, post transplant
What could you find in examination of someone with lymphoma?
hepatomegaly, splenomegaly, enlarged lymph nodes
What tests are vital when you suspect lymphoma?
bone marrow biopsy, CT TAP
blood film, lymph node biopsy, immunophenotyping
How is lymphoma staged?
Ann Arbor I - 1 lymph node 2 - 2< lymph nodes on the same side of diaphragm 3 - nodes on both sides of diapragm 4 - mets outside of lymph nodes
How do you treat lymphoma?
Chemo - ABVD (adriamycin, bleomycin, vinblastine, dacarbazine)
+ radio
What tests would you do for myeloma?
FBC, blood film, U&E, calcium, immunoglobulins
serum and urine electrophoresis
skeletal survey (pepper pot skull)
ESR if >50 with back pain
Why are myeloma patients prone to bacterial infections?
myelo-infiltration, bone marrow gets bunged up with cells, immunoglobulins under expressed
What are 4 acute complications of myeloma?
anaemia, AKI, fractures, spinal cord compression
What would a FBC of a patient with leukemia show?
low platelet, low Hb and high WCC
What would a blood film of leukemia show?
Acute - blast cells
Chronic - mature WC with full spectrum lineage
What is the breakthrough drug for leukemia?
imatinib - a monoclonal antibody which inhibits tyrosine kinase activity
What is myelodysplasia?
pre-malignant, condition of hematopoietic precursors
disease of elderly
How would you treat myelodysplasia?
supportive
bone marrow transplant in young
What is classic presentation of Hodgkin’s lymphoma?
What age group?
painless lymphadenopathy
15-35 years, >55 years
What is the 10 year survival of Hodgkin’s lymphoma?
10 year survival - 90%
What are myeloproliferative disorders and give some examples?
excess proliferation of bone marrow elements, especially blood cell precursors
CML
ET - essential thrombocytopenia
Myelofibrosis - marrow stroma proliferation
PRV - red cell proliferation
What are some causes of thrombocytopenia?
failure of production (vit B12 or folate deficiency, bone marrow infiltration, radiation, cytotoxic therapy)
increased consumption of platelets (ITP, DIC, HIV)
hypersplenism
What is primary thrombocytosis?
uncontrolled malignant proliferation of megakaryocytes
- bleeding, arterial and venous thrombosis
platelets >600
How do you treat primary thrombocytosis?
aspirin
hydroxycarbamide
anagrelide
interferon
What are some causes of secondary thrombocytosis?
bleeding, infection, inflammation, malignancy
What are the two types of thrombosis?
How would treat them?
arterial - platelet rich
- anti-platelet
venous - fibrin rich
- anticoagulant
What is myeloma?
accumulation of malignant plasma cells in bone marrow
What are the classifications of myeloma?
MGUS - <10% plasma cells
asymptomatic - >10% plasma cells, no symptoms
symptomatic - paraprotein in urine, clonal plasma in bone marrow, symptoms
