Concepts in Malignant Haematology Flashcards
how do you identify non-lymphoid cells from lymphoid cells?
morphology eg by blood count or film
how can you identify normal stem cells from other cells?
immunophenotyping
CD34 is an antigen often expressed on what cells…
stem cells
malignant haemopoiesis is characterised by 2 things, what are they?
inc numbers of abnormal + dysfunctional cells
loss of normal activity
what can cause blood cells to become dysfunctional or abnormal?
inc proliferation
lack of differentiation/maturation/apoptosis
what is the problem in acute leukaemia?
problem with differentiation/maturation of progenitor cells
describe levels of progenitor and differentiated cells in leukaemia
high progenitor cells (cant divide)
low differentiated cells
what kind of leukaemia DOES have normal differentiation of cells
chronic (only acute doesnt have differentiation of cells)
what is the problem in chronic leukaemia?
too many normal cells
differentiation/maturation is normal
what kind of mutation causes clonal expansion?
driver mutation
what is a “clone” in genetics
population of daughter cells derived from a single parent cells
how are clones helpful in cancer?
the parent cell has a genetic marker so you can trace the daughter cells back to their original parent cell because they will have the marker too
normal haemopoiesis is __clonal
poly
malignant haemopoiesis is __clonal
mono
monoclonal haemopoiesis…..
CANCER UNTIL PROVEN OTHERWISE
2 main branches of leukaemia
myeloid
lymphoid
if you have a cancer of your primitive lymphoid progenitor cells what is it called?
acute lymphoblastic leukaemia
if you have a cancer of your mature lymphoid cells what is it called?
CLL
what cancer can involve both blood and lymph nodes?
CLL
what is a myeloma?
cancer of plasma cells in the marrow
acute/chronic leukaemia is more severe
acute
describe features of aggressive cancer on histology
large cells with a big nucleus and nucleolus
rapid proliferation
how does bone marrow function differ between acute and chronic leukaemias?
acute has failure of BM function, chronic doesnt
chronic myeloid leukaemias tend to affect what cells of the haemopoesis tree
stem cells
acute myeloid leukaemias tend to affect what cells of the haemopoesis tree
primitive precursor cells
lymphomas tend to occur when problems arise in the maturation of what cell?
B cells
excess of blasts in the blood or bone marrow…
acute leukaemia
what are lymphoid progenitor cells collectively called?
lymphoblasts
most common childhood cancer?
acute lymphoblastic leukaemia?
clinical presentation of ALL
outside involvement eg CNS/testis
bone pain
marrow failure symptoms
what are symptoms of marrow failure
anaemia
infections
bleeding
who gets ALL
children
who gets AML
elderly >60
presentation of AML
outside involvement eg CNS/testis bone pain marrow failure symptoms gum infiltration DIC
NB VERY SIMILAR TO “ALL”
Ix acute leukaemia
- blood count and film
- coag screen
- bone marrow aspirate for film and immunophenotyping
describe a blood film of acute leukaemia
presence of auer rods
reduction in normal cells
presence of abnormal cells eg high nuclear:cytoplasmic ratio
morphological characteristic of AML
auer rods
what Ix provides a DEFINITIVE diagnosis
immunophenotyping
if bone marrow aspiration is contra-indicated/not helpful what could you do?
take a trephine (piece of bone)
Tx acute leukaemia
chemo
chemo is inserted via what line in leukaemia?
hickman line
complications of marrow suppression?
anaemia
neutropaenia
thrombocytopaenia
neutropenic patients are at risk of sepsis from what organisms (state the most and 2nd most likely)
- gram NEGATIVE bacteria
2. fungi
what drug used in leukaemia can cause cardiomyopathy?
anthracyclines
what is defined as remission in leukaemia
<5% marrow blasts with recovery of normal haemopoiesis
you are more likely to be cured of ALL in childhood/adulthood
childhood
