Haematological Malignancies In Practice Flashcards
54 yr old scaffolder
Tiredness over last 2-3 weeks
Over last 2 weeks - SOB and dizzy on climbing scaffold
Feeling hot and cold
Coughing up green phlegm
Examination:
Very pale
Temp 38.5
Dull percussion note R base with decreased air entry
Petichiae around ankles
FBC results:
Hb 45, MCV 92, WCC 0.9, Neutrophils 0.3, Plts 12
Diagnosis…
Acute myeloid Leukaemia
20 year old student
Presents with 1 month history of gradually increasing neck swelling
Weight loss of half a stone Generalised itch Night sweats O/E 2x3 cm cervical lymphadenopathy Also axillary lymphadenopathy FBC – normocytic normochromic anaemia, eosinophilia
Differential diagnosis?
Hodgkin’s Lymphoma Non-Hodgkin’s lymphoma Acute lymphoblastic leukaemia Metastatic non haematological malignancy Infections viral:`2 -EBV, CMV, HIV -Bacterial – draining, local lymph nodes -TB, toxoplasma
Further investigation if DD is hodgkins lymphoma
Lymph node biopsy
Virology
Presentatation of lymphoma
Lymphadenopathy Splenomegaly +/- hepatomegaly B symptoms fever >38oC weight loss >10% body weight in 6 mths night sweats Symptomatic anaemia or other cytopenias
75 year old man
Intermittent claudication for 2 years Admitted with painful toe Hb 159 120-160 MCV 74 82-99 RCC 6.2 3.8-5.0 WBC 11 4-10 Plts 850 140-400
Further investigations
FBC Blood film Inflammatory markers (ESR, CRP) Ferritin JAK2, CALR & MPL mutation screening Consider BCR-ABL Other investigations if clinical suspicion of malignancy Bone marrow examination not first line
75 year old man
Intermittent claudication for 2 years Admitted with painful toe Hb 159 120-160 MCV 74 82-99 RCC 6.2 3.8-5.0 WBC 11 4-10 Plts 850 140-400
ESR 24mm/hr, CRP <4
Ferritin 3
Positive for JAK2 V617F mutation
Polycythaemia vera
Causes of thrombocytosis
Infections Post surgery / trauma Malignancy Iron deficiency Inflammation – IBD, Rheumatoid arthritis Primary myeloproliferative disorder
Treatment of polycythaemia vera
Aspirin
Venesection
Hydroxycarbamide
55 year old man
Low back pain – progressively worse
Tired last few months
Previously fit and well
No weight loss
Investigations
FBC, ESR
U&E, Ca, Phos, Immunoglobulins & protein electrophoresis
Bence Jones protein (or serum free light chains)
Xray of spine
55 year old man
IGg kappa paraprotein
Paraspinal Mass
Diagnosis
Myeloma
Myeloma treamtent
Local – surgical decompression or radiotherapy Systemic – induction chemotherapy (various regimens) Bone protection (IV bisphosphonate Zolendronic acid) Consolidation (autologous stem cell transplant Maintenance (in clinical trial only in UK at present)
85 year old woman
Marked splenomegaly
Admitted for bladder repair
DD?
Low grade lymphoma
Chronic leukaemias (CML, CLL)
Myeloproliferative disorders
Portal hypertension / liver disease
Infiltration from sarcoidosis, other malignancies
Infections eg chronic malaria, visceral Leishmaniasis
85 year old woman
Marked splenomegaly
Admitted for bladder repair
Blood count – Hb 100, MCV 96, WCC 1.2, Neuts 0.5, Plts 58
Leukoerythroblastic blood film with teardrop poikilocytes, blasts and giant platelets
Extensive reticulin fibrosis in bone marrow
Diagnosis?
Myelofibrosis
Treatment for myelofibrosis
Transfusion, hydroxycarbamide, thalidomide, JAK2 inhibitors (Ruxolitinib), allogeneic stem cell transplantation
Possible causes of lymphocytosis
Viral infection (e.g. EBV, CMV, HIV) Other infections – TB, brucellosis, syphilis Vasculitis Acute lymphoblastic leukaemia Chronic lymphocytic leukaemia Lymphoma
