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

1
Q

List investigations for leukaemia

A

FBC, Blood film, Bone marrow examination - aspirate, trephine, immunophenotyping, cytogenesis and Bone marrow biopsy

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2
Q

What is acute leukaemia and what are the presenting symptoms

A

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

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3
Q

Outline acute myeloid leukaemia

A
  • Increases with age
  • It is recurrent with cryogenic abnormalities and these can predict the outcome so are key in prognosis and treatment planning
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4
Q

What are the risk factors for acute myeloid leukaemia

A
  • Radiation
  • Alkylating agents
  • Pre-existing myeloproliferative disorders
  • Genetic abnormalities
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5
Q

Outline acute lymphoid leukaemia

A
  • 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
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6
Q

Outline chronic myeloid leukaemia

A

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

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7
Q

What are the clinical features of chronic myeloid leukaemia (Someone with leukaemia shall be tiered because everyone frets)

A
  • Fatigue
  • Weight loss
  • Sweating
  • Splenomegaly
  • Bruising
  • Leucocytosis (neutrophils and myelocytes)
  • XS basophils, eosinophils
  • Thrombocytosis
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8
Q

Outline chronic lymphoid leukaemia

A
  • Commonest leukaemia increasing with age

- Usually an incidental finding with chronic indolent clinical course which may not require treatment

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9
Q

What are the clinical features of chronic lymphoid leukaemia (she has lymphoid leukaemia now we rest)

A
  • Lymphocytosis
  • Weight loss
  • Night sweats
  • Lymphadenopathy
  • Splenomegaly
  • Hepatomegaly
  • Recurrent infections
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10
Q

What is lymphoma

A

Malignancy of lymphoid tissue presenting with
- peripheral lymphadenopathy
- effects visceral lymph node masses
- bone marrow infiltration
Low grade quickly transforms into high grade

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11
Q

How is lymphoma diagnosed

A

LDH and inflammatory markers, cytopenia (bone marrow failure), biopsy, histology to confirm morphology, immunophenotype and cytogenetics

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12
Q

What is NHL

A

Non-Hodgkin’s Lymphoma = more common in western countries with increasing age (can be high/low grade)

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13
Q

What is high grade NHL

A

Aggressive disease needing combination chemotherapy

  1. Diffuse large B cell lymphoma (commonest)
  2. Burkitts lymphoma
  3. Lymphoblastic lymphoma
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14
Q

What is low grade NHL

A

Indolent disease needing expectant chemotherapy/ combined chemotherapy

  1. Follicular NHL (2nd commonest)
  2. Mantle Cell lymphoma
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15
Q

What is HL and its features

A

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
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16
Q

How is HL diagnosed

A

Lymph nodes show Reed-Sternberg cells and it presents as a mediastinal lymphadenopathy

17
Q

What is the treatment for HL

A
  • Chemotherapy
  • Radiotherapy
  • Combination chemotherapy
  • Targeted antibody therapy = Rituximab and Campath
18
Q

What is myeloma

A

Malignancy of plasma cells presenting with

  • paraprotein in serum
  • bone pain
  • renal failure
  • anaemia
19
Q

What is the treatment for myeloma

A

Chemotherapy and targeted therapies

20
Q

How is pain controlled in myeloma

A

Radiotherapy, Kyphoplasty = vertebral reconstruction, Analgesia and Bisphosphonates are given for bone care (MRONJ)

21
Q

What are myeloproliferative disorders

A

Proliferation of differentiated myeloid cells causing thrombosis/bleeding tendency (molecular cause = JAK2)

22
Q

What is essential thrombocythemia

A

Myeloproliferative disorder with raised platelets

23
Q

What is polycythemia rubra vera

A

Myeloproliferative disorder with raised platelets, haemoglobin and WBCs