Haem Malignancy- Leukaemia Flashcards

Question

What cells are proliferating in high numbers in CLL?

Answer 1

Mature B lymphocytes.

Answer 2

Chemotherapy Targeted immune treatments - ibrutinib. Ox Handbook: says above + - steriods for autoimmune haemolysis - radiotherapy for lymphadenopathy and splenomegaly - stem cell transplantion in some pts - supportive care - transfusions, IV immunoglobulins for recurrent infections

Answer 3

* 1/3 don't progress * 1/3 slowly progress * 1/3 actively progress * death often due to infection or transformation to an aggressive non-hodgkins lymphoma (Richter's syndrome)

Answer 4

It is defined as a temperature of greater than 38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 109/L or lower (i.e. having anticancer treatment)

Answer 5

**Cytotoxic chemotherapy** - chemo causes bone marrow suppression, leading to a temporary reduction in the production of blood cells, including neutrophils, which take time to be replaced (about 5-10 days --> this is why neutropenic sepsis commonly occurs 7-14 days after chemo. **Haemopoeitic stem cell transplantation** **immunosuppressive drugs** - azathioprine, methotrexate, sulfasalazine, adalimumab, and infliximab Other causes: Infections (HIV, EBV), Autoimmune (RA, Chron's), Bone marrow failure

Answer 6

Patients at high risk: * Have sustained, significant neutropenia that is expected to last more than 7 days. * Are clinically unstable * Have an underlying malignancy and are being treated with high-intensity chemo - usually AML * Have significant co-morbidities - DM, liver disease, renal disease * Age - infants, or over 60 * On corticosteriods

Answer 7

* death - delaying treatment is a cause of death; immediate treatments saves lives * Organ failure * Invasive and atypical infection * neutropenic enterocolitis * coagulopathy - DIC * encephalopathy and delirium * physical impairmens - chronic pain and fatigue * psych - PTSD, anxiety about recurrent infections

Answer 8

**coagulase-negative, Gram-positive bacteria are the most common cause, particularly Staphylococcus epidermidis** see pic

Answer 9

History: * Type and timing of chemo regimen and any other immunosuppressive medication being taken. * Localizing symptoms e.g right lower-quadrant pain associated with neutropenic enterocolitis * Recent infections and antibiotics used * Latent infections are known to reactivate (e.g. TB), sick contacts, blood transfusions * Co-morbidities * Any intravascular devices Examination: * DRABCDE * Systems-based examinations * ENT * Fundoscopy * DO NOT perform DRE until antibiotics given)

Answer 10

Investigations: * 2 sets of blood cultures * Swabs from any indwelling lines * Blood tests from complete blood cell count, WCC, inflammatory markers, renal and liver function. * CXR * Serology and PCR for viruses e.g. CMV * Sputum, urine, stool samples, CT scans etc. where clinically indicated

Answer 11

* antibiotics must be started **immediately**, do not wait for the WBC * NICE recommends starting empirical antibiotic therapy with piperacillin with tazobactam (**Tazocin**) **immediately** * (check local guidelines) * following this initial treatment patients are usually assessed by a specialist and risk-stratified to see if they may be able to have outpatient treatment * Daily measures of fever and baseline bloods until the patient is apyrexial and neutrophil count above 0.5x10^9^ * When the neutrophil count is normal, has been afebrile for 48 hours and blood tests have normalized, antibiotics can be stopped. Other added points: * if patients are still febrile and unwell after 48 hours an alternative antibiotic such as meropenem is often prescribed +/- vancomycin * if patients are not responding after 4-6 days the Christie guidelines suggest ordering investigations for fungal infections (e.g. HRCT), rather than just starting therapy antifungal therapy blindly

Answer 12

if it is anticipated that patients are likely to have a neutrophil count of < 0.5 * 109 as a consequence of their treatment they should be offered a **fluoroquinolone**

Answer 13

Binet staging system

Answer 14

Ritcher's transformation occurs when leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin's lymphoma. Patients often become unwell very suddenly. Ritcher's transformation is indicated by one of the following symptoms: lymph node swelling fever without infection weight loss night sweats nausea abdominal pain