Haematological malignancies 2 Flashcards
Which is the most common haematological malignancy seen in children?
Acute lymphoblastic leukaemia
General symptoms of haematological malignancy
- Bone marrow failure
- Anaemia
- Fatigue
- Pallor
- Thrombocytopaenia
- Bleeding: bruising and epistaxis
- Dysfunctional white cells
- Recurrent infections
- Anaemia
- Constitutional symptoms
- Weight loss
- Fatigue
- Fever
- Loss of appetite
- Infiltration
- Hepatosplenomegaly
- Lymphadenopathy
- Gum hyperplasia (AML)
General investigations in haematological malignancies
- Bedside
- Full set of observations Bloods
- FBC
- Blood film
- Clotting screen
- Imaging
- CT imaging
- Special tests
- Bone marrow aspirate and biopsy
- Lymph node biopsy
- Immunophenotype
- Genetic testing
Definition of acute lymphocytic leukaemia
Proliferation of immature lymphoid cells
Risk factors for acute lymphocytic leukaemia
- Age: bimodal distribution in childhood and adulthood
- Chemotherapy
- Radiotherapy
- Down syndrome: 20 fold greater risk
- Benzene
Which translocation is most commonly seen in children with ALL?
T(12;21)
Which tissues do ALL cells infiltrate?
- Liver
- Spleen
- Lymph nodes
- Parotid
- Testicle
- CNS
What does the FBC, blood film and bone marrow biopsy show in acute lymphoblastic leukaemia?
- FBC: leukocytosis, thrombocytopenia, anaemia
- Blood film: immature lymphoblasts
- Bone marrow biopsy: ≥20% lymphoblasts
Poor prognostic factors in acute lymphocytic leukaemia
- Age < 1 or >10
- WCC > 30 at diagnosis
- t(9;22)
- Extramedullary disease
- eg CNS involvement
Definition of chronic lymphocytic leukaemia
Neoplastic proliferation of mature B lymphocytes
Which is the most common haematological malignancy in adults?
Chronic lymphocytic leukaemia?
Risk factors for chronic lymphocytic leukaemia?
- Age: median age at diagnosis is 70
- Sex: male > female (2:1)
- White ethnicity
FBC, blood film and bone marrow biopsy results in chronic lymphocytic leukaemia
- FBC: leukocytosis, thrombocytopenia, anaemia
- Raised lymphocyte count
- Blood film: increased number of lymphocytes and smudge cells
- Bone marrow biopsy: increased number of lymphocytes and few immature cells
Complications of chronic lymphocytic leukaemia
- Hypogammaglobulinaemia: recurrent infections
- Warm autoimmune haemolytic anaemia
- Richter transformation
- Transformation into diffuse large B cell lymphoma
Myeloma definition
Neoplastic proliferation of the same type of plasma cell in the bone marrow
Clinical features of myeloma
- Hypercalaemia
- Bone pain
- Renal colic
- Abdominal pain; constipation
- Anaemia
- Amyloidosis
- Macroglossia
- Carpal tunnel syndrome
- Peripheral neuropathy
- Monoclonal antibody proliferation
- Recurrent infection
Investigations in myeloma
- Bedside
- Urine dip: proteinuria
- Bloods
- FBC: anaemia, pancytopaenia
- Blood film: rouleaux formation
- U&Es: renal failure
- Bone profile: hypercalcaemia and raised ALP
- Serum electrophoresis: paraprotein band (M-spike)
- Imaging
- Whole body MRI: identify bone marrow infiltration
- Special tests:
- Bone marrow biopsy: ≥10% plasma cell infiltration
- Urine electrophoresis: Bence-Jones proteins (light chains)
Managment of myeloma
- Chemotherapy
- Stem cell transplantation
- Conducted in those with good performance status who are <70 years old
- Bisphosphonates: Zoledronate
History and examination
A 70-year old presents to the GP complaining of back pain for the last 2 months. He feels more lethargic compared to normal.
Examination reveals a normal spleen and liver, with no evidence of lymphadenopathy.
Hb: 90 g/L (130-180 g/L)
Calcium: 3.5 mmol/L (2.1-2.6 mmol/L)
Myeloma
A 70 year old presents to the GP complaining of lethargy. On examination, he has hepatosplenomegaly and enlarged cervical lymph nodes.
Blood results reveal lymphocytosis.
Chronic lymphocytic leukaemia
A 6 year old with Down syndrome presents to the GP with his mum. She complains he has been feeling more tired over tha last few weeks and bruises very easily.
On examination, he has a palpable liver and spleen.
Acute lymphocytic leukaemia
