CBL Long Case 2 - Leukaemia

Question 1

Define pancytopenia [1]

Answer 1

reduced WBCs, Hb and platelets

Question 2

What are the possible causes of a pancytopenia? [3]

Answer 2

1. a variety of bone marrow diseases
2. hypersplenism
3. peripheral consumption of blood cells

Question 3

What are the possible causes of a purpuric rash? [2]

Answer 3

1. platelet problem (usually thrombocytopenia) or
   
   • with thrombocytopenia, spontaneous purpura seldom occurs with platelet count >20x10⁹L
2. vasculitis

Question 4

What is the significance of blast cells in the peripheral blood? [3]

Answer 4

1. blast cells are primitive cells
2. may be malignant but can also be “normal” primitive cells
   
   • myeloid and erythroid blasts in a leucoerythroblastic blood sample are normal primitive cells pushed out of the bone marrow by fibrotic tissue (myelofibrosis) or malignant infiltration by carcinomas

Question 5

Describe the most frequent presentations of acute leukaemia in children and adults [5]

Answer 5

1. bone marrow failure
2. anaemia
3. infections due to neutropenia
4. bleeding due to thrombocytopenia
5. bone pain due to leukaemic cell expansion in marrow cavity

Question 6

What is the most common type of acute leukaemia in children? [1]

Answer 6

acute lymphoblastic leukaemia (ALL)

Question 7

What is the most common type of acute leukaemia in adults? [1]

Answer 7

acute myeloid leukaemia (AML)

Question 8

Describe the specific investigations appropriate for a patient suffering from possible acute leukaemia [3]

Answer 8

1. bone marrow examination
2. flow cytometry
   
   • type the cells with immunofluorescence labelled monoclonal antibodies
3. cytogenetics
   
   • looking for chromosomal abnormalities (e.g. Philadelphia chromosome)

Question 9

Describe the different types of treatment options for patients with acute leukaemia [3]

Answer 9

1. supportive treatment
   
   • RBC and platelet transfusions & antibiotics
   • given to elderly/more frail patients whom cannot withstand intensive chemotherapy
2. palliative treatment
3. intensive chemotherapy

Question 10

What is a bone marrow transplant (BMT)? [1]

Answer 10

a means of replacing malignant stem cells with normal (donor) stem cells