Haematology 14 - Interactive leukaemia cases

Question 1

• A 5-year-old boy of Indian ethnic origin presented with lymphadenopathy and a mediastinal mass on chest radiology
• WBC 180 × 109/l, Hb 93 g/l and platelet count 43 × 109/l

Answer 1

T cell ALL

Question 2

What is a bad prognostic marker in ALL?

Answer 2

High WCC

Question 3

How would you confirm the diagnosis in case 1?

Answer 3

Immunophenotyping

Question 4

Normal PT but short APTT and low fibrinogen…

Answer 4

Suggests DIC as have normal clotting time but with a low level of fibrinogen

Question 5

What test would you do to confirm the diagnosis of APML over AML?

Answer 5

FISH/Cytogenetic analysis/molecluar genetic analysis –> t(15;17)

FISH will show the fusion gene: PML-RARA
Cytogenetics shows t(15;17)

Question 6

APML survival

Answer 6

90% 5 year survival

Question 7

Normal level of blasts in BM aspirate

Answer 7

<5%

Question 8

Blood film of someone with B12 deficiency

Answer 8

Megaloblasts
Hypersegmented neutrophils
Oval macrocytes
Poikilocytes

Question 9

If you are suspecting polycythaemia vera, what is the next investigation to diagnose?

Answer 9

look for JAK2 mutation

Question 10

Management of PRV

Answer 10

Venesection + hydroxycarbamide