Condition- Acute Leukaemia (AML, ALL)

Question 1

List some of the common symptoms of acute leukaemias (can be classed into two main groups)

Answer 1

• Symptoms of BM failure
  
  • Anaemia- SOB, fatigue
  • Thrombocytopenia- bruising, bleeding (epistaxis, gums)
  • Neutropenia- recurrent infection
• Symptoms of tissue infiltration (ALL>AML)
  
  • bone pain
  • abdo discomfort due to hepatosplenomaegaly (T-cells)
  • Mild, localised body pains due to lymphadenopathy (T-cells)
  • Meningismus symptoms- vision disturbance, headaches)
  • Mediastinal enlargement- wheeze, stridor (T-cells)
• FLAWS (fever especially)

Question 2

List some of the signs of acute leukaemias (can be classed into 2 groups)

Answer 2

• Signs of BM failure
  
  • Anaemia- pallor
  • Thrombocytopenia- petechiae
  • Neutropenia- skin rashes, pyrexia, ulcers
• Signs of tissue infiltration (ALL>AML)
  
  • Lympadenopathy (T-cells)
  • Thymus enlargement (T-cells)
  • Hepatosplenomegaly
  • Testicular swelling
  • Neuro signs
    
    • CN palsies
    • Meningismus signs
    • Papilloedema
    • Retinal haemorrhages

Question 3

Which type of leukaemia is more common in children?

Answer 3

Acute Lymphoblastic Leukaemia (ALL: L=little)

Question 4

Define ALL

Answer 4

Sudden onset malignancy of bone marrow characterised by proliferation of lymphoblasts

Question 5

Which type of mutation tends to cause ALL? and give two examples

Answer 5

Chromosomal Translocations

t(12,21) => ETV6:RUNX1 mutation

t(9,22) => BCR:ABL aka Philadelphia Chromosome

Question 6

Which cell tends to be affected in ALL?

Answer 6

3/4 are B cell ALL (proliferation of B-cell lymphoblasts)

Question 7

Define AML

Answer 7

Proliferation of myeloblasts in BM

Question 8

List some risk factors for AML

Answer 8

• Down’s Syndrome
• Chemotherapy agents
• Irradiation
• Pre-existing haematological condition e.g. Myelodysplastic sydrome
• Older age

Question 9

Which test is required to confirm a diagnosis of AML or ALL? What would be a positive result?

Answer 9

BM aspiration:

Hypercellularity + >20% lymphoblasts/ myeloblasts

Can also do immunophenotyping

Question 10

Gingivitis may arise in which type of leukaemia and why?

Answer 10

AML

Due to monocytic infiltration of the gums

Question 11

List some distinct features of AML on a blood film

Answer 11

• Myeloblasts
• Auer rods

Question 12

List two dermatological manifestations of leukaemias

Answer 12

Sweet’s syndrome (fever, painful rash)

Pyoderma Gangrenosum

More common in AML

Question 13

List 4 features of Acute Promyelocytic Leukaemia (an agressive form of AML)

Answer 13

• Bilobed nuclei
• Multiple Auer rods
• Lymphoblasts
• Hypergranulated

Question 14

Which system is used to classify AML?

Answer 14

FAB (French-American-British scale)

Question 15

What would you see in the FBC of someone with acute leukaemias?

Answer 15

• Low Hb and low RBC
• High WCC but Low neutrophils
• Low platelets
• High LDH (high metabolism)
• High uric acid (^)
• Should have normal clotting might be mildly prolonged

Question 16

When might clotting screens be abnormal? Which leukaemia is this associated with?

Answer 16

DIC which is associated with AML

• Have prolonged PT, APTT, low fibrinogen and raised D-dimer
• This is because myeloblasts activate clotting cascade

Question 17

State the differences between AML and ALL

Answer 17

ALL

• Children
• Presents with BM failure and tissue infiltration
• Specific : Thymic enlargement, lymphadenopathy
• Blood film: Small lymphoblasts, course chromatin, smaller nucleoli

AML

• Adults
• Presents mainly with BM failure
• Specific: DIC and Gingivitis
• Blood film: Large myeloblasts, fine chromatin, large nucleoli, AUER RODS!!