H3: Haematological malignancies Flashcards
1. Review features of lymphoid malignancies an myeloma-proliferative disorders 2. Describe and outline clinical features of the following - AML - ALL - CML - CLL - HL - NHL - Myelo-proliferative disorders
List investigations for leukaemia
FBC, Blood film, Bone marrow examination - aspirate, trephine, immunophenotyping, cytogenesis and Bone marrow biopsy
What is acute leukaemia and what are the presenting symptoms
Fatal when untreated as fast growing, can be myeloid/lymphoid, presents with symptoms of bone marrow failure = anaemia, easy bruising, infection and is treated with intensive chemotherapy
Outline acute myeloid leukaemia
- Increases with age
- It is recurrent with cryogenic abnormalities and these can predict the outcome so are key in prognosis and treatment planning
What are the risk factors for acute myeloid leukaemia
- Radiation
- Alkylating agents
- Pre-existing myeloproliferative disorders
- Genetic abnormalities
Outline acute lymphoid leukaemia
- Mainly in children
- Treated with chemotherapy (poor survival in adults)
- Management is supportive care: neutropenic care, mouth care, reverse barrier nursing, viral-antifungal prophylaxis + antibiotics, blood product support, anti-emetics
Outline chronic myeloid leukaemia
Associated with Philadelphia chromosome = translocation of chromosomes 9 and 22 creating an abnormal fusion protein BCR/ABL with constitutive TK activity: It is treated with Imatinib
What are the clinical features of chronic myeloid leukaemia (Someone with leukaemia shall be tiered because everyone frets)
- Fatigue
- Weight loss
- Sweating
- Splenomegaly
- Bruising
- Leucocytosis (neutrophils and myelocytes)
- XS basophils, eosinophils
- Thrombocytosis
Outline chronic lymphoid leukaemia
- Commonest leukaemia increasing with age
- Usually an incidental finding with chronic indolent clinical course which may not require treatment
What are the clinical features of chronic lymphoid leukaemia (she has lymphoid leukaemia now we rest)
- Lymphocytosis
- Weight loss
- Night sweats
- Lymphadenopathy
- Splenomegaly
- Hepatomegaly
- Recurrent infections
What is lymphoma
Malignancy of lymphoid tissue presenting with
- peripheral lymphadenopathy
- effects visceral lymph node masses
- bone marrow infiltration
Low grade quickly transforms into high grade
How is lymphoma diagnosed
LDH and inflammatory markers, cytopenia (bone marrow failure), biopsy, histology to confirm morphology, immunophenotype and cytogenetics
What is NHL
Non-Hodgkin’s Lymphoma = more common in western countries with increasing age (can be high/low grade)
What is high grade NHL
Aggressive disease needing combination chemotherapy
- Diffuse large B cell lymphoma (commonest)
- Burkitts lymphoma
- Lymphoblastic lymphoma
What is low grade NHL
Indolent disease needing expectant chemotherapy/ combined chemotherapy
- Follicular NHL (2nd commonest)
- Mantle Cell lymphoma
What is HL and its features
Hodgkin’s lymphoma which is the commonest malignancy between 15-35yo
- Painless lymphadenopathy
- Splenomegaly
- Extra nodal spread to bone marrow/lungs/liver
- Drenching night sweats, fever and weight loss
