Haematology Flashcards
What is the commonest cancer seen in the paediatric population?
Leukaemia
What is the peak incidence of acute lymphoblastic leukaemia (ALL)?
2-5 years
Describe how a child with ALL would present.
The specific symptoms of leukaemia are due to deficiency of the three main cell lines, so history compatible with anaemia (lethargy, looking pale), thrombocytopaenia (easy bruising/bleeding) and leukopaenia (fevers/infections) are common. Children may also complain of bone pain as a result of increased pressure from hyperplastic marrow.
More non-specific symptoms of malignancy, such as weight loss and malaise are also common. Occasionally, children may present with signs of central nervous system (CNS) involvement, such as headache or seizures.
Describe what laboratory tests in a child with ALL would show.
Full blood count – likely to show either pancytopaenia or anaemia and thrombocytopaenia with a significant lymphocytosis
Blood film – likely to show the presence of blast cells
How long is maintenance treatment of ALL?
2 years for girls and 3 years for boys
In the immediate management of a child presenting with a very high WCC we hyper-hydrate them to avoid what complication?
Hyper-viscosity
Which cells do not drop in numbers in ALL?
Immature Blast cells- Disruption in the regulation and proliferation of lymphoid precursor cells in the bone marrow leads to excessive production of immature blast cells and drop in the other three cell lines.
What two categories is lymphoma divided into?
Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
What virus as been particularly implicated int the development of lymphoma?
EBV
Describe how a child with lymphoma would present.
Lymphoma may present with a visible or palpable mass. There may be a history of “B symptoms” such as:
Weight loss
Night sweats
Fevers
Other, more non-specific symptoms of malignancy, such as lethargy and anorexia, may also be present.
Describe what you would find on examination of a child with lymphoma.
Non-tender lymphadenopathy is the most common examination finding, however this may not necessarily be visible or palable, for example if mediastinal or intra-abdominal lymph nodes are involved. Mediastinal lymphadenopathy may present with cough, wheeze or other difficulty in breathing, and occasionally superior vena cava obstruction or airway compromise can occur.
What enzyme is usually elevated in a blood test of a child with lymphoma?
LDH - Lactate dehydrogenase
Describe the 4 stages of lymphoma.
Stage 1: Disease is present in a single group of lymph nodes or a single organ
Stage 2: Disease is present in 2 or more groups of lymph nodes or organs on the same side of the diaphragm
Stage 3: Disease is present in lymph nodes or organs on both sides of the diaphragm
Stage 4: There is diffuse involvement of lymph nodes and organs such as the liver and bones
Which type of lymphoma carries a more favourable prognosis?
Hodgkins lymphoma
What is used to manage a potentially compromised airway from mediastinal masses?
Airway support and high dose steroids
