Haematology 2 Flashcards
What are the 5 things that may have caused leukemia?
1) Radiation
2) Chemicals such as benzenes
3) Viruses (human T cell leukaemic virus)
4) Genetic factors
5) Acquired hematological disorders
During leukaemia, neoplastic cells can spill to peripheral blood, what can this lead to?
- Spread to bone marrow affects important cell lines (results in anaemia)
- Impacts immune system
- Impacts coagulation from platelets leading to bleeding
- Abnormal cells spill to liver&kidney, bones, testicles and even the gingiva.
What happens when neoplastic cells spill out the bone marrow?
What organs do they tend to go to?
- Spillage to other organs such as lymph nodes causing lymphadenopathy, liver, spleen, CNS, bones, testicles and gingiva.
How do we classify leukaemia?
- Acute/Chronic
- Myeloid/Lymphoid
What is acute lymphoblastic leukemia?
How do we manage this?
Cancer of white blood cells (lymphocytes) that progresses quickly.
Management:
- Non-myelosuppressive chemotherapy
What is acute myeloid leukaemia?
How is it managed?
Cancer of myeloid cells that progressives quickly.
Managed with intensive chemotherapy.
What is chronic lymphocytic leukaemia?
How is it managed?
Production of underdeveloped lymphocytes over a long time.
Chemotherapy.
What are chronic lymphocytic leukaemia symptoms?
- Feeling unwell
- Swelling of lymph nodes
- Recurrent infections
- Abnormal blood cell count
What is chronic myeloid leukemia and what are the clinical features?
Cancer of myeloid cells occurring over a long period of time.
Signs:
- Bone marrow failure
- Losing weight
- Night sweats
What chromosome is associated with chronic myeloid leukemia?
Philadelphia chromosome.
What is the dental relevance of leukaemia?
- Gingival bleeding, oral ulceration, sore mouth and increased susceptibility to infections
What is a lymphoma and what are the two classifications?
Cancer of the lymphatic system (lymph nodes, thymus, spleen and bone marrow).
Hodgkin’s disease = nodal (involves lymph nodes)
Non Hodgkin’s disease = extra nodal and associated with many diseases and outcomes
What is Hodgkin’s disease and what are the clinical features?
Hodgkin’s disease = cancer of lymphatic system that sticks to lymph nodes.
Clinical Features:
- Lymphadenopathy (particularly of the cervical lymph chain)
- B symptoms
- Fatigue
- Itchy red rashes
- Mediastinal lymph node involvement
How do we stage Hodgkin’s disease?
1 = Single LN region 2 = Two LN regions 3 = Groups on both side of diaphragm 4 = Widespread disease outside lymphatic tissue
How do we investigate Hodgkin’s disease?
INVESTIGATIONS:
- Full blood cell count
- Renal blood tests
- Chest CT scans
- Lymph node biopsy
- Increase in ESR (inflammatory markers)
How do we manage Hodgkin’s disease?
INVESTIGATIONS:
- Full blood cell count
- Renal blood tests
- Chest CT scans
- Lymph node biopsy
- Increase in ESR (inflammatory markers)
TREATMENT:
- Chemotherapy and radiotherapy in the early stage
- Combination of both in the later stages
What is non hodgkin’s disease?
What are some suggested causes?
Cancer that is extra nodal and is associated with many diseases.
Causes suggested:
- Immunodeficiency
- Infections
- Ionising radiation
- Carcinogenic chemicals
What are the clinical features of non hodgkin’s disease?
What is the management?
- Swollen lymph nodes
- Oropharyngeal involvement
- Bone marrow infiltration (anaemia, recurrent infections, haemorrhage)
Management:
LOW GRADE - may need no treatment or intermittent oral chemotherapy
HIGH GRADE - combination chemotherapy needed
What is multiple myeloma?
Plasma cells undergo malignant transformations.
This leads to the secretion of monoclonal immunoglobulins.
What are the clinical features of multiple myeloma?
1) Bone destruction - myeloma cells stimulate osteoclasts
2) Bone marrow failure - marrow infiltration results in anaemia, thrombocytopenia, neutropenia and recurrent infections
3) Renal failure - accumulation of paraproteins within the kidney
4) Hyperviscosity syndrome - due to increase in protein in blood leading to headaches
5) Amyloidosis - abnormal protein cells with deposit in tissues and organs)
How do we investigate and manage multiple myeloma?
Investigations:
- assess bone marrow failure
- evidence of inflammation with raised ESR and Ca2+
- renal function tests looking for damage
- protein electrophoresis which shows presence of the monoclonal paraprotein (these proteins can also be screened in the urine - pence-jones proteins)
Management = only treated if there is evidence of organ damage.
- Chemotherapy may be started.
- Most patients response but relapse is common.
- Radiotherapy is used in patients with bone pain.
What are the oral manifestations of leukaemia and lymphomas?
- Manifestations anaemia
- Hemorrhagic tendency
- Increased risk of infection
- Neutropenic ulceration
Multiple myeloma leads to leukemic infiltration.
- What is this? How does it affect the dentition?
Leukemic cells move out the bone marrow and into various tissues.
This can go into the gingiva and bone.
Leads to tooth mobility
Multiple myeloma leads to leukemic infiltration.
- What is this? How does it affect the dentition?
Leukemic cells move out the bone marrow and into various tissues.
This can go into the gingiva and bone.
Leads to tooth mobility.
What lymphomas appear intra orally?
Typically non hodgkin’s lymphomas
When treating leukaemia and lymphoma, what are the oral complications?
- Mucositis (ulceration due to chemo and radio therapy - increases infection risk)
- Trismus
- Damage to taste buds
- Osteoradionecrosis
- Osteomyelitis
Why do we need to have good oral care when we have leukemia or lymphoma?
If there are complications to the gingiva and bone, we need to ensure good oral hygiene to reduce the affects of these.
We need to complete a 2 week interval between extractions and commencing radiotherapy.
What can we do for these patients if chemotherapy fails?
- Stem cell transplant
- Can be from the patient or from a donator
- If from a donator, patient can get an immune reaction to own tissues and organs of body (allogenic HSCT diseasE)
