Haematology Flashcards
What is lymphoproliferative disease?
neoplastic, clonal proliferation of lymphoid cells
basically cancer of white blood cells
What are the 2 classes go lymphoma?
Hodgkin lymphoma
Non-hodgkin lymphoma (2 classes: aggressive and indolent)
What are the classes of non-hodgkin lymphoma other than aggressive and indolent?
B cells - 90%
T cells - 10%
NK cells - <1%
At what rate does indolent lymphoma progress?
slow growing and advanced at presentation
Is indolent lymphoma curable?
no.
What are the subtypes of indolent lymphoma?
follicular
marginal zone
mantle cell
CLL
What is the survival of indolent lymphoma?
median survival of 9-12 years but variable across sub-groups
What are the risk factors of indolent lymphoma?
most cases cause is unknown
primary immunodeficiency (e.g. wiscott-aldrich syndrome, common variable immunodeficiency)
secondary immunodeficiency (e.g. HIV, transplant recipients)
infection (e.g. EBV, HTLV-1, Helicobacter pylori)
autoimmune disorders
How do most indolent lymphomas present?
painless lymphadenopathy
What investigations can confirm a diagnosis of indolent lymphoma?
lymph node biopsy- core needle biopsy/ excision node biopsy (not FNA)
bone marrow biopsy
Why is existent of a breast lump relevant to diagnosing lymphoma?
If a patient has breast cancer the tumour may spread to axilla, so it wouldn’t actually be lymphoma but a spread of the breast cancer
How do we stage indolent lymphoma?
Lugano staging classification typical for most indolent lymphomas, requires imaging (CT neck, thorax, abdomen, pelvis, PET-CT)
bloods
bone marrow
What are B symptoms?
fever
night sweats
weight loss
What is the treatment for indolent lymphoma?
incurable
watch and wait/ active surveillance for asymptomatic patients, follow up regularly, does compromise overall survival
radiotherapy for symptomatic patients for palliative reasons
What are the types of chemoimmunotherapy?
alkylating agents (e.g. chlorambucil, bendamustine, cyclophosphamide)
anthracyclines (e.g. doxorubicin)
vina alkaloids (e.g. vincristine)
corticosteroids
mostly use combinations of these
What are myelodysplastic syndromes?
abnormal bone marrow syndromes
What does ‘myelo’ mean?
marrow
What is acute myeloid leukaemia?
AML is a heterogenous clonal malignancy characterised by:
- immature myeloid cell proliferation
- bone marrow failure
What is the main risk of myelodysplastic syndromes?
they can progress to acute myeloid leukaemia
How do myelodysplastic syndromes cause harm?
- bone marrow cells fail to make enough healthy blood cells (quantity and quality of cells are effected)
- abnormal cells crowd out remaining normal cells
- risk of progression to acute myeloid leukaemia
What are cytopenias?
low blood cell counts
can be red cells, white cells or platelets
How does low red cell count present?
fatigue
shortness of breath
lightheadedness
How does low white cell count present?
increased risk of frequent and/ or severe infections
How does low platelet count present?
bleeding/ bruising
How do you diagnose AML?
full blood count/ blood film
white cells can be low, normal or high but red cells and platelets will be low
bone marrow aspirate and trephine biopsy
What is the morphology of myelodysplastic syndrome?
- requirement of 10% dysplasia in any cell line(s)
- blast % can be anywhere from 0-19%
What do you do if there are blasts on a FBC?
refer straight to haematology- there shouldn’t be any blasts on the FBC
What is the morphology of myeloid leukaemia?
minimum 20% blasts
What is paraprotein?
abnormal immunoglobulins produced by clonal plasma cells
What are the signs and symptoms of multiple myeloma?
CRAB
C- hyperCalcaemia
R- renal impairment, oedema, decreased urine output
A- anemia, neutropenia, thrombocytopenia
B- osteolytic bone lesions: pepper pot skull
What other rare syndromes might a patient present with in multiple myeloma?
paraethesia
fever (<1%)
splenomegaly (1%)
hepatomegaly (4%)
lymphadenopathy (1%)
neurological syndromes: hyperviscocity syndrome, spinal cord compression
What % of patients with multiple myeloma will experience spinal cord compression?
5%
What investigations can confirm a diagnosis of multiple myeloma?
bloods
protein electrophoresis and immunofixation
urine protein electrophoresis
serum light free chains
bone marrow aspirate/ biopsy
skeletal survey (x-ray)
CT/MRI
beta-2 microglobulin
How does multiple myeloma show on a blood test?
FBC- marrow failure
ESR- raised
blood film- rouleaux formation
U&Es- raised urea and creatinine
Hypercalcemia
How does multiple myeloma show on protein electrophoresis and immunofixation tests?
increased number of antibodies
monoclonal protein band
How does multiple myeloma show on protein electrophoresis and immunofixation tests?
increased number of antibodies
monoclonal protein band
How does multiple myeloma show on urine protein electrophoresis?
Bence Jones’ protein- monoclonal light chains
How does multiple myeloma show on serum free light chains test?
ratio of light chains kappa and lambda
How does multiple myeloma show on a bone marrow biopsy?
increased plasma cell
How does multiple myeloma show on an x-ray/ skeletal survey?
lytic lesions
pepper pot skull
vertebral collapse
lytic punched out lesions
fracture risk
How does multiple myeloma show on a CT/MRI?
lesions that may not have been identified on x-ray
What is the principle behind treatment of multiple myeloma?
it is incurable, so treatment aims to increase periods of disease remission
What is induction therapy in multiple myeloma?
initial treatment option
combination of 3 drugs
this treatment is dependent on high-risk features and co-morbidities
Give an example of induction therapy for multiple myeloma.
VELCADE (bortezomib)- protease inhibitor
REVLIMIN (lenalidomide)- immunomodulatory imide drug
inhibits tumour angiogenesis, tumour-secreted cytokines and tumour proliferation
induces apoptosis
DEXAMETHASONE- steroid
What is ASCT in multiple myeloma?
autologous stem cell transplant
best treatment option for long periods of remission
is combined with high dose chemo (e.g. melphalan)
What drugs are used to maintain remission for multiple myeloma?
bortezomin/ lenalidomide
Which molecule is a prognostic tool for multiple myeloma?
beta2 micro-globulin
How is multiple myeloma staged?
Uses international staging system (ISS) for myeloma which grades based on levels of serum beta-2 micro globulin and albumin levels
stage 1: median survival 62 months
stage 2: median survival 44 months
stage 3: median survival 29 months
What are the three categories of red cell disorders?
haemoglobinopathies
membranopathies
enzymopathies
What is a haemoglobinopathy?
deficiency related to low quality or quantity of haemoglobin production
What is membranopathy?
deficiency related to red blood cell membrane protein
What is enzymopathy?
deficiency related to RBC enzyme synthesis, leads to shortened lifespan due to oxidative stress
What is the normal range for haemoglobin?
120-180g/L
What is the difference between adult and foetal haemoglobin?
adult (HbA): 2 alpha and 2 beta chains
foetal (HbF): 2 alpha and 2 gamma chains
What is haemoglobin S?
variant of Hb arising from a point mutation in the beta globin gene, leading to a single amino acid change (valine to glutamine)
What is sickle cell disease?
a haemoglobin disorder of quality- polymerisation of HbS results in characteristic sickle shaped RBCs
What is the lifespan of a sickle cell?
5-10 days- described as haemolytic
What factors can precipitate sickling in sickle cell anaemia?
trauma
cold
stress
exercise
Why does sickle cell anaemia not present until after 6 months old?
HbF is not affected by sickle cell anaemia as it is made up of 2 alpha and 2 gamma chains
How does sickle cell anaemia affect reticulocyte count?
raised- 2-3% (normally 0.45-1.8%)
Why is reticulocyte count raised in sickle cell anaemia?
sickle cell disease is haemolytic- increased degradation of RBcs
production is inceased
reticulocyte count is raised
Why is reticulocyte count raised in sickle cell anaemia?
sickle cell disease is haemolytic- increased degradation of RBcs
production is inceased
reticulocyte count is raised
What drug is used to prevent painful crises in people with sickle cell anaemia?
hydroxycarbamide