Haematological malignancies Flashcards
1
Q
What are the Ganulocytes (3)
A
- Neutrophils (“PMN”, main WBC, 60%)
- Eosinophils
- Basophils (“Mast cell”, when in tissue)
2
Q
What are the agranulocytes (2)
A
- Monocyte/Macrophage (name when in tissue)
- Lymphocyte (B / plasma cells & T-cells)
3
Q
What are the disorders associated with leukocytes (2)
A
- leukocytosis
- leukopenia
4
Q
What is leukocytosis (3)
A
- excess
- Indicative of infection
- Indicative of leukaemia
5
Q
What is leukopenia (4)
A
- deficit
- Indicative of poisoning
- Radiation sickness
- Immunosuppressive infection (HIV-AIDS)
6
Q
How are disorders with leukocytes diagnosed (2)
A
- Bone marrow aspiration and biopsy
- Complete blood count
7
Q
What are common symptoms of leukaemia (13)
A
- Weight loss
- Fever
- Frequent infections
- Easy shortness of breath
- Muscle weakness
- Bone/joint pain or tenderness
- fatigue
- Loss of appetite
- Swelling in lymph nodes
- Spleen and/or liver enlargement
- Night sweats
- Easy bleeding and bruising
- Purplish patches or spots on the skin
8
Q
What are the classifications of haematological malignancies (8)
A
- Historically divided by whether cells are mainly located
- in the blood (leukaemia)
- in lymph nodes (lymphoma)
- in bone, plasma cell disorders (Myeloma)
- More recently, greater emphasis on cell lineage (WHO)
- Leukaemia total percentage = 30.4%
- Lymphoma total percentage = 55.6%
- Myeloma total percentage = 14.0%
9
Q
What are leukaemias (5)
A
- Progressive proliferation of leukocytes from either of 2 lineages
- Lineage 1 = lymphocytic (ie. B, T)
- Lineage 2 = myeloid (ie. non-lymphocytic – granulocytes, monocytes, RBC or platelets).
- Acute Leukaemia = immature (blast) cell proliferation
- Chronic Leukaemia = mature (lymphocyte or granulocyte) proliferation
10
Q
What are lymphomas (3)
A
- Only lymphocyte lineages
- Type 1 = HD, Hodgkin’s disease
- Type 2 = NHL, non-Hodgkin’s lymphoma
11
Q
What are plasma cell disorders (3)
A
- Antibody-secreting cells overproduce immunoglobulins (Igs)
- E.g. Waldenstrom’s macroglobulinaemia (IgM)
- E.g. Multiple myeloma (IgG, A, D, E)
12
Q
What is leukopenia (2)
A
- Leukopenia = reduction in wbc
- most commonly neutrophils = neutropenia (granulocytopenia).
13
Q
What is the goal of AML (ANLL) treatment
A
Clear bone marrow and periphery of dividing leukaemic blast cells to allow normal regeneration.
14
Q
What are the drugs for AML (ANLL) treatment (4)
A
- to interfere with cell cycle or division: Anthracyclines
- Cytotoxic antibiotics - daunorubicin & idarubicin
- Antimetabolites - Cytarbine
15
Q
What are the classifications of chemotherapeutics by modes of action (7)
A
- Alkylating agents (cyclophosphamide)
- Antimetabolites (restrict availability of bases: methotrexate; cytarbine)
- Anthracyclines (cytotoxic antibiotics - daunorubicin & idarubicin)
- Plant alkaloids - Microtubule polymerase/synthesis inhibitors (vincristine)
- Topoisomerase inhibitors (etoposide)
- Monoclonal antibodies (Rituximab)
- Tyrosine kinase inhibitors
16
Q
What is non-Hodgkin’s lymphomas aetiological association (5)
A
- Infection, eg Epstein-Barr virus, T-cell lymphotropic virus.
- Immunodeficiency, eg immunosuppressive therapy, HIV.
- Autoimmune disorder.
- Irradiation or carcinogens.
- Inherited disorder, eg. ataxia telangiectasia as risk factor.
17
Q
What happens with non-Hodgkins lymphomas (8)
A
- B or T lymphocytic forms
- relatively poor prognosis, compared to Hodgkin’s lymphoma.
- Classification (Rye / Ann Arbor) used to direct therapy
- Low, medium or high grade description, depending on cell type, size & distribution.
- Most patients have III or IV stage and are therefore limited in therapy:
- Radiotherapy has good prognosis but not curative in the unusual case of stage I, low grade n-HL.
- MAb - Rituximab (anti CD20, surface antigen of B-cells); also for low grade lymphoma
- Usually no treatment for other stages; except for removal of large tumor mass - chlorambucil.
18
Q
What is combination chemotherapy (CHOP) (6)
A
- Used for most high-grade lymphomas
- C = Cyclophosphamide
- H = Hydroxydaunomycin (Doxorubicin)
- O = Oncovin (Vincristine)
- P = Prednisolone
- CHOP treats Lymphoblastic lymphomas (tumours) or leukaemias (blood-borne).
19
Q
What is Venesection (3)
A
- bloodletting surgical incision used to treat haemochromatosis/polycythaemia
- effective at reducing circulating red-cell mass (haematocrit), but not circulating platelets.
- Iron deficiency side-effect (sore tongue; angular stomatitis - cracks in corners of mouth) requires oral iron salt replacement.
20
Q
What is radiotherapy (RTx) including radioactive phosphorus (32P) (2)
A
- marrow irradiation – reduction in all cell counts & platelets.
- Risk of haemorrhage (bleeding) and leukaemia.
21
Q
What are cytotoxic drugs: Hydroxycarbamide (hydroxyurea); Busulfan (3)
A
- effective at reducing all cell counts & platelets.
- Risk of haemorrhage (bleeding; poor proliferative repair) and leukaemia (disordered division?).
- Hyper-uric-aemia (gout). Treated with Allopurinol (PTO)
22
Q
What is Allopurinol (2)
A
- to treat hyper-uric-aemia (gout) produced by cytotoxic drugs
- cause large scale release of nucleic acids.
23
Q
What is interferon alpha (2)
A
- recent use in preference over hydroxycarbamide, for CML & polycythaemia.
- but not tolerated in all patients.
24
Q
What are blood transfusions used for (2)
A
- for anaemia from pathology or therapy.
- but K raised; also iron overload.
25
What is splenectomy (2)
1. to treat splenomegaly (painful abdominal swelling) from accretion of cells in spleen for removal.
2. Immunodeficiency results - requires prophylactic preoperative vaccination & post operative penicillin.
26
What is bone marrow transplantation
induction (harvesting) before replacement.
27
Hemophilia is characterized by a deficiency in:
Clotting factors
28
Aplastic anemia is caused by:
Bone marrow failure
29
