Cancers of the blood Flashcards
What is leukaemia
- name for cancer of a particular line of the stem cells in the bone marrow
- causes unregulated production of certain types of blood cells
- can be classified depending on how rapidly they progress (acute/chronic)
- cell line that is affected (myeloid or lymphoid)
What are the 4 main types of leukaemia
Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia
What is the pathophysiology behind leukaemia
- Genetic mutation in one of the precursor cells in the bone marrow leads to excessive production of a single type of abnormal white blood cell.
- excessive production of a single type of cell can lead to suppression of the other cell lines
- This results in a pancytopenia
What is a pancytopaenia
combination of:
- low red blood cells (anaemia)
- low white blood cells (leukopenia)
- low platelets (thrombocytopenia).
What ages does leukamia usually affect
- “ALL CeLLmates have CoMmon AMbitions”
- progressive ages of the different leukaemia from 45-75 in steps of 10 years
Under 5 and over 45
Acute lymphoblastic leukaemia (ALL)
Over 55
chronic lymphocytic leukaemia (CeLLmates)
Over 65
chronic myeloid leukaemia (CoMmon)
Over 75
acute myeloid leukaemia (AMbitions)
What is the presentation of leukaemia
Fatigue Fever Failure to thrive (children) Pallor due to anaemia Petechiae and abnormal bruising due to thrombocytopenia Abnormal bleeding Lymphadenopathy Hepatosplenomegaly
Differential Diagnosis of Petechiae
Leukaemia Meningococcal septicaemia Vasculitis Henoch-Schonlein Purpura (HSP) Idiopathic Thrombocytopenia Purpura (ITP) Non-accidental injury
What is petechiae
bleeding under the skin leading to bruising and petechiae caused by thrombocytopenia (low platelets).
What investigations should be done if suspected Leukaemia
- Full blood count is the initial investigation: within 48 hours for patients with suspected leukaemia.
- Blood film: look for abnormal cells and inclusions.
- Lactate dehydrogenase (LDH)
- Bone marrow biopsy: definitive diagnosis of leukaemia.
- Chest xray: infection or mediastinal lymphadenopathy.
- Lymph node biopsy
- Lumbar puncture: if there is CNS involvement.
- CT, MRI and PET for staging
Who should referred immediately to hospital if suspected leukaemia
Children or young adults with ptechiae or hepatosplenomegaly should be referred immediately to hospital.
What is lactate dehydrogenase
a blood test that is often raised in leukaemia but is not specific to leukaemia. It can be raised in other cancers and many non-cancerous diseases.
What is a bone marrow aspiration
involves taking a liquid sample full of cells from within the bone marrow.
What is a bone marrow trephine
involves taking a solid core sample of the bone marrow and provides a better assessment of the cells and structure.
Explain bone marrow biopsy
- usually taken from the iliac crest.
- involves a local anaesthetic and a specialist needle.
- Samples from bone marrow aspiration can be examined straight away however a trephine sample requires a few days of preparation.
What is Acute Lymphoblastic Leukaemia
- malignant change in one of the lymphocyte precursor cells
- causes acute proliferation of a single type of lymphocyte, usually B-lymphocytes
- most common cancer in children (peaks 2-4 years)
- can also affect adults over 45
- often associated with Downs syndrome.
What would you see on blood film in a patient with Acute Lymphoblastic Leukaemia
blast cells
What genetic mutations is Acute Lymphoblastic Leukaemia associated with
- t(15:17) translocation in 30% children
- Philadelphia chromosome (t(9:22) translocation) in 30% of adults
What is Chronic Lymphocytic Leukaemia
- chronic proliferation of a single type of well differentiated lymphocyte, usually B-lymphocytes
- usually affects adults over 55 years of age
What is Richter’s transformation.
CLL can transform into high-grade lymphoma.
What is the presentation of chronic lymphocytic laeukaemia
- Often asymptomatic
- infections
- anaemia
- bleeding
- weight loss
- can cause warm autoimmune haemolytic anaemia.
What would you see on blood film in a patient with chronic lymphocytic leukaemia
- “smear” or “smudge” cells: occur during the process of preparing the blood film where aged or fragile white blood cells rupture and leave a smudge on the film.
What are the 3 phases of Chronic Myeloid Leukaemia
- chronic phase
- accelerated phase
- blast phase
What is the accelerated phase in Chronic Myeloid Leukaemia
- abnormal blast cells take up a high proportion of the cells in the bone marrow and blood (10-20%)
- patients become more symptomatic, develop anaemia and thrombocytopenia and become immunocompromised.
What is the blast phase in Chronic Myeloid Leukaemia
- Follows the accelerated phase and involves an even high proportion of blast cells and blood (>30%).
- This phase has severe symptoms and pancytopenia
- Often fatal.
What is Acute Myeloid Leukaemia
- most common acute leukaemia in adults
- can present at any age but normally presents from middle age onwards
- Can be the result of a transformation from a myeloproliferative disorder
What is seen on blood film in Acute Myeloid Leukaemia
- high proportion of blast cells
- auer rods in their cytoplasm
What are the complications of chemotherapy
Failure Stunted growth and development in children Infections due to immunodeficiency Neurotoxicity Infertility Secondary malignancy Cardiotoxicity Tumour lysis syndrome
What is the management of leukaemia
- oncology multi-disciplinary team
- primarily treated with chemotherapy and steroids.
- Other therapies include: Radiotherapy, Bone marrow transplant, Surgery
What is Tumour Lysis Syndrome
- release of uric acid from cells that are being destroyed by chemotherapy which form crystals in the interstitial tissue and tubules of the kidneys and causes acute kidney injury.
How can you reduce high uric acid levels in patient recieving chemotherapy
- hyperhydration
- Allopurinol or rasburicase
Why do we measure calcium in patient receiving chemo
- Chemicals such as potassium and phosphate are released
- High phosphate can lead to low calcium, which can have adverse effect
What is lymphoma
- group of cancers that affect the lymphocytes inside the lymphatic system.
- cancerous cells proliferate within the lymph nodes and cause the lymph nodes to become abnormally large (lymphadenopathy).