HAEMATOLOGY Flashcards
what are the investigations for CLL?
● Normal or low Hb
● Raised WCC with very high lymphocytes
● Blood film – smudge cells may be seen in vitro
What is the treatment for CLL?
- Watch and wait
- Chemotherapy
- Monoclonal antibodies, e.g. rituximab
- Targeted therapy, e.g. bruton kinase inhibitors (ibrutinib)
- human IV immunoglobulins
what is the epidemiology of ALL?
Mainly a childhood disease
highest prevalence between 2-4yrs
Associated with Down’s syndrome
Associated with ionising radiation
what are the investigations for ALL?
● FBC and blood film
o WCC = high
o Blast cells on film and in bone marrow
● CXR and CT scan looking for mediastinal and abdominal lymphadenopathy
● Lumbar puncture to look for CNS involvement
Give 3 environmental causes of leukaemia
- Radiation exposure
- Chemicals (benzene compounds)
- Drugs
What is lymphoma?
Malignant proliferation of B and T lymphocytes in the lymph nodes
Although predominantly in the lymph nodes, what other organs can lymphoma effect?
- Blood
- Bone marrow
- Liver
- Spleen
Give 4 risk factors for lymphoma
- Primary immunodeficiency
- Secondary immunodeficiency - HIV, transplant recipients
- Infections - EBV, H. pylori, HTLV-1
- Autoimmune disorders - SLE, RA
Describe the pathophysiology of lymphoma
Impaired immunosurveillance and infected B cells escape regulation and proliferate
What are the 2 sub-types of lymphoma
- Hodgkins lymphoma
2. Non-hodgkins lymphoma
What are signs and symptoms of Hodgkins lymphoma?
- Fever and sweating
- Enlarged rubbery non-tender nodes
- Systemic ‘B’ symptoms, e.g. fever
- Painful nodes on drinking alcohol
- some patients (commonly young women) have disease localised to the mediastinum
What is needed for the diagnosis of Hodgkins lymphoma?
Presence of Reed-Sternberg cells (in lymph node biopsy)
What blood results may you seen in someone with Hodgkins lymphoma?
High ESR FBC - anaemia (normochromic normocytic) Reed Sternberg cells Low Hb High serum lactase dehydrogenase
Describe the staging go Hodgkins lymphoma
Stage 1 = confined to a single lymph node region
Stage 2 = Involvement of two or more nodal areas on the same side of the diaphragm
Stage 3 = Involvement of nodes on both sides of the diaphragm.
Stage 4 = Spread beyond the lymph nodes e.g. liver.
Each stage is either ‘A’ - absence of ‘B’ symptoms or ‘B’ - presence of ‘B’ symptoms
What the treatment for Hodgkins lymphoma?
ABVD chemotherapy regime
marrow transplant
What are the possible complications of treatment for Hodgkins lymphoma?
- Secondary malignancies
- IHD
- Infertility
- Nausea
- Alopecia
What is non-hodgkins lymphoma?
Any lymphoma not involving Reed-Sternberg cells
what are the signs and symptoms of non-hodgkins lymphoma?
Fever and sweating
Enlarged rubbery non-tender nodes
Systemic ‘B’ symptoms, e.g. fever
GI and skin involvement
What is the treatment for non-hodgkins lymphoma?
Steroids
Monoclonal antibodies to CD20 -> Rituximab
CHOP regimen
What is anaemia?
A reduced RBC mass +/- reduced Hb concentration
What is the functions of Hb?
It carries and delivers oxygen to tissues
What organs are responsible for the removal of RBCs?
- Spleen
- Liver
- Bone marrow
- Blood loss
what are the causes of microcytic anaemia?
- Iron deficiency
- Chronic disease - cancer, HF, CKD
- Thalassaemia
what are the causes of normocytic anaemia?
- Acute blood loss
- Chronic disease
- Combined haematinic deficiency (iron and B12 deficiency)
- renal failure
- pregnancy
- hypopituitarism, hypothyroidism, hypoadrenalism