Blood cancers

Question 1

What is myeloma?

Answer 1

malignant proliferation of B lymphocytic plasma cells

Question 2

What are the symptoms of myeloma?

Answer 2

bone pain, tired, night sweats, stones
paraprotein production = renal failure and raised calcium
recurrent infections
bruising easily

Question 3

How would you manage myeloma?

Answer 3

analgesia, chemo (VAD), bisphosphonates
blood transfusions
antibiotics
stem cell transplant

Question 4

What are the two types of lymphoma?

Answer 4

Hodgkin’s - Reed-Steinberg cell (from B lymphocytes)

Non-Hodgkin’s - no Reed-Steinberg cells, B or T cells (slow growing but incurable)

Question 5

What are the symptoms of lymphoma?

Answer 5

enlarged lymph nodes, compression syndromes, systemic B symptoms (weight loss, night sweats)

Question 6

How would you treat lymphoma?

Answer 6

Hodgkin’s - AVBD chemo and radio, stem cell transplant

Non- H - anti-CD20 on B cells, ritiximab

Question 7

What is lymphoma?

Answer 7

malignant growth of WBC, especially in the lymph nodes

Question 8

What is leukemia?

Answer 8

bone marrow produces increased numbers of immature or abnormal WBC

Question 9

What are the 4 types of leukemia?

Answer 9

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)

Question 10

What are the symptoms of leukemia?

Answer 10

anaemia, flu-like, bleeding and bruising due to decreased platelets, enlarged spleen, enlarged lymph nodes

Question 11

How would you treat leukemia?

Answer 11

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

Question 12

What cell is diagnostic of Hodgkin’s lymphoma?

Answer 12

binucleated Reed-Sternberg cell

Question 13

What are some B symptoms of lymphoma?

How common are they?

Answer 13

Weight loss (>10% in 6 months), loss of appetite, night sweats, fever (>38), fatigue, itching, alcohol induced pain in lymph nodes
25% of cases

Question 14

What are the lymph node symptoms of lymphoma?

Answer 14

painless on palpation, rubbery texture, typically cervical

Question 15

What are some risk factors for lymphoma?

Answer 15

peaks in incidence in teens and elderly

family history, EBV, SLE, post transplant

Question 16

What could you find in examination of someone with lymphoma?

Answer 16

hepatomegaly, splenomegaly, enlarged lymph nodes

Question 17

What tests are vital when you suspect lymphoma?

Answer 17

bone marrow biopsy, CT TAP

blood film, lymph node biopsy, immunophenotyping

Question 18

How is lymphoma staged?

Answer 18

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

Question 19

How do you treat lymphoma?

Answer 19

Chemo - ABVD (adriamycin, bleomycin, vinblastine, dacarbazine)
+ radio

Question 20

What tests would you do for myeloma?

Answer 20

FBC, blood film, U&E, calcium, immunoglobulins
serum and urine electrophoresis
skeletal survey (pepper pot skull)
ESR if >50 with back pain

Question 21

Why are myeloma patients prone to bacterial infections?

Answer 21

myelo-infiltration, bone marrow gets bunged up with cells, immunoglobulins under expressed

Question 22

What are 4 acute complications of myeloma?

Answer 22

anaemia, AKI, fractures, spinal cord compression

Question 23

What would a FBC of a patient with leukemia show?

Answer 23

low platelet, low Hb and high WCC

Question 24

What would a blood film of leukemia show?

Answer 24

Acute - blast cells

Chronic - mature WC with full spectrum lineage

Question 25

What is the breakthrough drug for leukemia?

Answer 25

imatinib - a monoclonal antibody which inhibits tyrosine kinase activity

Question 26

What is myelodysplasia?

Answer 26

pre-malignant, condition of hematopoietic precursors

disease of elderly

Question 27

How would you treat myelodysplasia?

Answer 27

supportive

bone marrow transplant in young

Question 28

What is classic presentation of Hodgkin’s lymphoma?

What age group?

Answer 28

painless lymphadenopathy

15-35 years, >55 years

Question 29

What is the 10 year survival of Hodgkin’s lymphoma?

Answer 29

10 year survival - 90%

Question 30

What are myeloproliferative disorders and give some examples?

Answer 30

excess proliferation of bone marrow elements, especially blood cell precursors
CML
ET - essential thrombocytopenia
Myelofibrosis - marrow stroma proliferation
PRV - red cell proliferation

Question 31

What are some causes of thrombocytopenia?

Answer 31

failure of production (vit B12 or folate deficiency, bone marrow infiltration, radiation, cytotoxic therapy)
increased consumption of platelets (ITP, DIC, HIV)
hypersplenism

Question 32

What is primary thrombocytosis?

Answer 32

uncontrolled malignant proliferation of megakaryocytes
- bleeding, arterial and venous thrombosis
platelets >600

Question 33

How do you treat primary thrombocytosis?

Answer 33

aspirin
hydroxycarbamide
anagrelide
interferon

Question 34

What are some causes of secondary thrombocytosis?

Answer 34

bleeding, infection, inflammation, malignancy

Question 35

What are the two types of thrombosis?

How would treat them?

Answer 35

arterial - platelet rich
- anti-platelet
venous - fibrin rich
- anticoagulant

Question 36

What is myeloma?

Answer 36

accumulation of malignant plasma cells in bone marrow

Question 37

What are the classifications of myeloma?

Answer 37

MGUS - <10% plasma cells
asymptomatic - >10% plasma cells, no symptoms
symptomatic - paraprotein in urine, clonal plasma in bone marrow, symptoms