Haem - Leukaemia Flashcards
What is leukaemia?
Cancer of the stem cells in the bone marrow
Leading to unregulated production of blood cells
What are the different types of leukaemia that affect children?
Acute lymphoblastic leukaemia (most common)
Acute myeloid leukaemia
Chronic myeloid leukaemia
What age are most patients affected by leukaemia?
60-70 in most patients
Acute lymphoblastic leukaemia most commonly under 5
What are the key differentiating features between different types of leukaemia?
AML
Transformation from a myeloproliferative disorder
Auer rods
CML
3 phases including a long chronic phase
Philadelphia chromosome
ALL
Children
Down Syndrome
CLL
Warm haemolytic anaemia
Richter’s transformation cells
Smudge cells
What is the pathophysiology of leukaemia
Mutation in precursor cells, leads to excessive production of abnormal white cells
Excessive production can lead to suppression of other cell lines leading to underproduction
This can cause a pancytopenia
How does leukaemia present?
Think cytopenia-based symptoms e.g. anaemia, leucopenia and thrombocytopenia
Fatigue
Fever
Pallor
Petechiae
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
Failure to thrive (kids)
What causes petechiae and abnormal bruising?
Thrombocytopenia
What are the different types of petechiae?
Petechiae
Less than 3mm
Burst capillaries
Purpura
3-10mm
Ecchymosis
> 1cm
What are the differentials for a non-blanching rash?
Leukaemia
Meningococcal sepsis
Vasculitis
HSP
Immune thrombocytopenic purpura
Thrombotic thrombocytopenic purpura
Traumatic or mechanical
Non-accidental injury
When is non-accidental injury considered as a differential for a non-blanching rash?
Children
Vulnerable adults
How is suspected leukaemia managed?
Suspected cancer
FBC within 48 hours
Children or young people with petechiae or hepatosplenomegaly sent for immediate specialist assessment
What investigations are used for leukaemia?
FBC - initial investigation
Blood film - abnormal cells and inclusions
LDH - non-specific marker of tissue damage, can be raised even after exercise
Bone marrow biopsy - analyse cells to establish leukaemia
CT and PET scans - stage the condition
Lymph node biopsy - assess abnormal lymph node
Genetic tests - chromosome and DNA changes
Immunophenotyping - look for specific proteins on surface of cells to guide treatment and prognosis
Outline bone marrow biopsy
Taken from iliac crest
Requires local anaesthetic
Either aspiration or trephine
Bone marrow aspiration
Liquid sample of cells from bone marrow
Bone marrow trephine
Solid core sample of bone marrow
Better assessment of cells and structure
Outline acute lymphoblastic leukaemia
Affects one of the lymphocyte precursor cells
Causes acute proliferation of a single type of lymphocyte usually B-lymphocytes excessive accumulation replaces other cell types in the bone marrow causing pancytopenia
Affects kids under 5 but also older adults
More common with Down’s Syndrome
Can be associated with Philadelphia chromosome (more associated with CML)
Outline chronic lymphocytic leukaemia
Slow proliferation of a single type of well-differentiated lymphocyte usually B-lymphocytes
Affects over 60s
Often asymptomatic but can present with infections, anaemia, bleeding and weight loss
Can cause a warm autoimmune haemolytic anaemia
Richter’s transformation - rare transformation of CLL into high-grade B-cell lymphoma
Smear or smudge cells - ruptured white blood cells that occur when preparing the blood film because they are aged or fragile
What do blood films and bone marrow biopsy show in acute myeloid leukaemia?
High proportion of blast cells
Auer rods in cytoplasm of blast cells are characteristic of AML
