Cancer 5: Overview of blood cancers Flashcards
Explain the process of haemtopoiesis for a neutrophil
myeloblast -> promyelocyte -> myelocyte -> metamyelocyte -> band neutrophil -> neutrophil
Explain the process of haemtopoiesis for a macrophage
myeloblast -> promonocyte -> monocyte -> macrophage
what growth factor stimulates neutrophil growth?
G-CSF
what is cancer?
Transformed cell phenotype
– Uncontrolled proliferation
– Failure to undergo apoptosis
what are the clinical features of a proliferative state?
splenomegaly
hepatomegaly
thrombocytopaenia
polycythaemia
what do we see on bone marrow microscopy?
polycythaemia rubra vera
myelofibrosis
what do we see on blood film microscopy?
leucoarthroblastic blood picture
explain how JAK-STAT signalling leads to AML
mutated JAK2 leads to reactive fibrosis
what is CML?
too many white cells
what chromosome is linked to CML?
philadephia
what does CML lead to?
AML
what is leukaemia?
Uncontrolled proliferation of primitive cells in the bone marrow causing bone marrow failure. Leads to: 1) anaemia 2) infection 3) bleeding
what do we see on film for AML?
Leukaemic blasts
what are the clinical features of AML?
anaemia, infections, DIC, ulcers, infiltration and bruising
how do we diagnose AML ?
1) Bone marrow biopsy
2) cytogenic
3) molecular
4) immunophenotyping
how is leukaemia treated? (3)
• Chemotherapy – kills rapidly dividing cells: – Combination regimes – Myelo-ablative cycles of treatment • Supportive therapy: – Antibiotics, antifungals – Transfusions of blood and platelets • Stem cell transplantation: – Autograft – Allograft (full or reduced intensity) • Sibling • Matched donor
what is the AML treatment regime?
1) induction
2) consolidation 1/2/3
3) possible stem cell transplant or further consolidation.
Explain the process of allogenic transplantation
1) bone marrow aspirated from iliac crest of donor and can do T cell depletion
2) recipient undergoes high dose chemo and radiotherapy
3) donor stem cells are infused IV.
4) patient gets intensive support with antibiotics/cyclosporin and methotrexate.
what is neutropenic sepsis?
MEDICAL EMERGENCY – High risk of death
how do you manage neutropenic sepsis?
Blood cultures and blind antibiotic therapy if fever > 38°C
• 1
st line – Tazocin (Piperacillin/Tazobactam) +/- Gentamicin
• 2
nd line – Switch to Meropenem +/- Teicoplanin (for Gram +ve)
• 3
rd line – Add anti-fungal e.g. Ambisome (Amphotericin)
• Resuscitate patient with i.v. fluids if hypotensive
• May require inotropic support on ITU
name some opportunistic infections you may get
PCP
fungal infections