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YR3 HUD > Haematology 2 > Flashcards

Haematology 2 Flashcards

1
Q

What are the 5 things that may have caused leukemia?

A

1) Radiation
2) Chemicals such as benzenes
3) Viruses (human T cell leukaemic virus)
4) Genetic factors
5) Acquired hematological disorders

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2
Q

During leukaemia, neoplastic cells can spill to peripheral blood, what can this lead to?

A
  • 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.
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3
Q

What happens when neoplastic cells spill out the bone marrow?

What organs do they tend to go to?

A
  • Spillage to other organs such as lymph nodes causing lymphadenopathy, liver, spleen, CNS, bones, testicles and gingiva.
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4
Q

How do we classify leukaemia?

A
  • Acute/Chronic

- Myeloid/Lymphoid

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5
Q

What is acute lymphoblastic leukemia?

How do we manage this?

A

Cancer of white blood cells (lymphocytes) that progresses quickly.

Management:
- Non-myelosuppressive chemotherapy

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6
Q

What is acute myeloid leukaemia?

How is it managed?

A

Cancer of myeloid cells that progressives quickly.

Managed with intensive chemotherapy.

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7
Q

What is chronic lymphocytic leukaemia?

How is it managed?

A

Production of underdeveloped lymphocytes over a long time.

Chemotherapy.

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8
Q

What are chronic lymphocytic leukaemia symptoms?

A
  • Feeling unwell
  • Swelling of lymph nodes
  • Recurrent infections
  • Abnormal blood cell count
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9
Q

What is chronic myeloid leukemia and what are the clinical features?

A

Cancer of myeloid cells occurring over a long period of time.

Signs:

  • Bone marrow failure
  • Losing weight
  • Night sweats
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10
Q

What chromosome is associated with chronic myeloid leukemia?

A

Philadelphia chromosome.

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11
Q

What is the dental relevance of leukaemia?

A
  • Gingival bleeding, oral ulceration, sore mouth and increased susceptibility to infections
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12
Q

What is a lymphoma and what are the two classifications?

A

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

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13
Q

What is Hodgkin’s disease and what are the clinical features?

A

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
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14
Q

How do we stage Hodgkin’s disease?

A 
1 = Single LN region
2 = Two LN regions
3 = Groups on both side of diaphragm
4 = Widespread disease outside lymphatic tissue
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15
Q

How do we investigate Hodgkin’s disease?

A

INVESTIGATIONS:

  • Full blood cell count
  • Renal blood tests
  • Chest CT scans
  • Lymph node biopsy
  • Increase in ESR (inflammatory markers)
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16
Q

How do we manage Hodgkin’s disease?

A

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
17
Q

What is non hodgkin’s disease?

What are some suggested causes?

A

Cancer that is extra nodal and is associated with many diseases.

Causes suggested:

  • Immunodeficiency
  • Infections
  • Ionising radiation
  • Carcinogenic chemicals
18
Q

What are the clinical features of non hodgkin’s disease?

What is the management?

A
  • 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

19
Q

What is multiple myeloma?

A

Plasma cells undergo malignant transformations.

This leads to the secretion of monoclonal immunoglobulins.

20
Q

What are the clinical features of multiple myeloma?

A

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)

21
Q

How do we investigate and manage multiple myeloma?

A

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.
22
Q

What are the oral manifestations of leukaemia and lymphomas?

A
  • Manifestations anaemia
  • Hemorrhagic tendency
  • Increased risk of infection
  • Neutropenic ulceration
23
Q

Multiple myeloma leads to leukemic infiltration.

- What is this? How does it affect the dentition?

A

Leukemic cells move out the bone marrow and into various tissues.
This can go into the gingiva and bone.
Leads to tooth mobility

24
Q

Multiple myeloma leads to leukemic infiltration.

- What is this? How does it affect the dentition?

A

Leukemic cells move out the bone marrow and into various tissues.
This can go into the gingiva and bone.
Leads to tooth mobility.

25
Q

What lymphomas appear intra orally?

A

Typically non hodgkin’s lymphomas

26
Q

When treating leukaemia and lymphoma, what are the oral complications?

A
  • Mucositis (ulceration due to chemo and radio therapy - increases infection risk)
  • Trismus
  • Damage to taste buds
  • Osteoradionecrosis
  • Osteomyelitis
27
Q

Why do we need to have good oral care when we have leukemia or lymphoma?

A

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.

28
Q

What can we do for these patients if chemotherapy fails?

A
  • 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)

YR3 HUD (23 decks)

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