Haematology Flashcards by Tom Bell

Multiple Myeloma is cancer of what cell?

Plasma cell

How well did you know this?

Not at all

Perfectly

What can happen to the blood and urine in multiple myeloma?

Monoclonal immunoglobulin or free light chains can be present

How well did you know this?

Not at all

Perfectly

What affect does multiple myeloma have on the body - what does it affect?

1) Bone marrow failure
2) Renal failure
3) Destructive bone disease
4) Hypercalcaemia

How well did you know this?

Not at all

Perfectly

Why are bones affected in Multiple Myeloma?

1) Rapid growth of myeloma cells inhibits osteoblast formation
2) Myeloma cells release OAFs that stimulate osteoclasts - reducing bone

How well did you know this?

Not at all

Perfectly

What is the condition called that is Pre-asymptomatic myeloma?

Monoclonal gammopathy of undetermined significance

How well did you know this?

Not at all

Perfectly

What are the criteria for MGUS for MIg and percentage of plasma cells in the bone marrow?

1) MIg <30g/L

2) <10% plasma cell in bone marrow

How well did you know this?

Not at all

Perfectly

What is asymptomatic myeloma criteria?

1) >10% plasma cells in bone marrow

2) No related organ or tissue involvement

How well did you know this?

Not at all

Perfectly

What are the clinical entities of symptomatic myeloma?

1) Paraprotein
2) Clonal plasma cells in bone marrow
3) Related organ or tissue involvement

How well did you know this?

Not at all

Perfectly

What are the 6 common presenting features of Multiple myeloma?

1) Tiredness and malaise
2) Bone/back pain
3) Infections
4) Anaemia,
5) Renal failure
6) Hypercalcaemia

How well did you know this?

Not at all

Perfectly

How are bones assessed in multiple myeloma?

Plain X-ray

How well did you know this?

Not at all

Perfectly

What treatment is done in asymptomatic Multiple myeloma?

Watch and wait - regular monitoring

How well did you know this?

Not at all

Perfectly

What is the treatment for symptomatic multiple myeloma?

1) Induction treatment and Stem cell transplant

2) Non-invasive drug treatment

How well did you know this?

Not at all

Perfectly

In addition to the chemotherapy what supportive treatment is given in multiple myeloma?

1) Biphosphates
2) Blood transfusions
3) Pain-killers
4) anti-thrombotic medication

How well did you know this?

Not at all

Perfectly

What chemotherapeutic drug is given alongside stem cell transplant in myeloma?

Melphalan

How well did you know this?

Not at all

Perfectly

What drug is given on the first relapse of myeloma?

Velcade

How well did you know this?

Not at all

Perfectly

What drug is given on the second relapse of myeloma?

Revlimid

How well did you know this?

Not at all

Perfectly

What is Lymphoma?

The malignant growth of lymphocytes predominately in the lymph nodes

How well did you know this?

Not at all

Perfectly

What is the cause of most Lymphomas?

Unknown

How well did you know this?

Not at all

Perfectly

What can cause Lymphoma?

1) Primary Immunodeficiency
2) Secondary immunodeficiency
3) Infection
4) Autoimmune disorders

How well did you know this?

Not at all

Perfectly

What type immunodeficiency is Wiscott-Aldrich an example of?

Primary immunodeficiency

How well did you know this?

Not at all

Perfectly

What type of immunodeficiency is HIV?

Secondary immunodeficiency

How well did you know this?

Not at all

Perfectly

How does EBV cause lymphoma?

Infects B cells which escape immunosurveillance and avoid regulation and proliferate

How well did you know this?

Not at all

Perfectly

What is the is the common presentation of Lymphoma?

1) Lump e.g. in the neck or arm
2) Compression syndrome - blood supply compression leads to oedema
3) B type systemic symptoms - loss of weight, loss of appetite and night sweats

How well did you know this?

Not at all

Perfectly

How is Lymphoma diagnosed?

1) Blood film
2) Bone marrow biopsy
3) Lymph node biopsy
4) Immunophenotyping - CD markers
5) Cytogenetics
6) Molecular - PCR

How well did you know this?

Not at all

Perfectly

What is the WHO performance Status 0?

Asymptomatic

What is the WHO Performance Status 1?

Symptomatic but completely ambulatory

What is the WHO Performance Status 2?

Symptomatic but <50% of daytime in bed

What is the WHO Performance Status 3?

Symptomatic but >50% of the day in bed

What is the WHO performance Status 4?

Symptomatic and Bedbound

What is the WHO Performance Status 5?

Death

What are the two main sub-types of Lymphoma?

1) Hodgkin's Lymphoma | 2) Non-Hodgkin's Lymphoma

What is used to distinguish between Hodgkin's and non-Hodgkin's Lymphoma?

The presence of Reed-Sternberg cells

Which type of Lymphoma has Reed-Sternberg cells present?

Hodgkin's Lymphoma

How does Hodgkin's Lymphoma present?

1) Painless lymphoadenopathy | 2) B symptoms

How does Non-Hodgkin's Lymphoma present?

Can have same symptoms as Hodgkin's but more varied

How is Hodgkin's Lymphoma staged?

Staged I-IV and termed A or B if B symptoms are not present or present

How is less advanced (1-2A) Hodgkin's Lymphoma treated differently to more advanced (2B-4) disease

1-2A: Short course chemo and radiotherapy | 2B-4: Combination chemotherapy

Why does the treatment vary depending on the staging?

Early stages are localized and so radiotherapy can be useful whereas later stages are more diffuse and therefore would not benefit from radiotherapy

What is the treatment for a relapse in Hodgkin's Lymphoma?

Bone Marrow Transplantation

What two subtypes are there of Non-Hodgkin's Lymphoma?

1) Indolent/Low grade | 2) Aggressive/High grade

What are the characteristics of indolent NHL?

1) Slow growing 2) Typically advanced at presentation 3) Incurable

What is the treatment for indolent NHL?

Sometimes do nothing but can: - Combination chemo - Monoclonal antibodies - Radiotherapy - Bone marrow transplant

What is the presentation of Aggressive NHL?

1) Nodal Presentation 2) Extranodal - 1/3 3) Patient feels unwell 4) Often short history

What is the treatment for aggressive NHL?

Early - short course chemotherapy and radiotherapy | Late - Combination chemotherapy and monoclonal antibodies

What type of medication is Ritximab?

Monoclonal antibody - anti CD-20 (expressed on B cells)

What is Acute Myeloid Leukaemia (AML)?

Malignancy of myeloblasts

What is Chronic Myeloid Leukaemia (CML)?

Malignancy affecting basophils, neutrophils and eosinophils

What is Chronic Myelomoncytic Leukaemia (CMML)?

Malignancy of monocytes

What is Acute Lymphoblastic Leukaemia (ALL)?

Malignancy of lymphoblasts

What is Chronic Lymphocytic Leukaemia (CLL)?

Malignancy of B lymphocytes

What defines Acute Leukaemia?

When there is more than 20% blasts in the blood

What are blast cells?

They are abnormal immature white blood cells

What is done to diagnose Leukaemias?

1) Blood film 2) Bone marrow Biopsy 3) Lymoh node biopsy 4) Immunophenotyping 5) Genetics - cytogenetics, PCR

Acute Myeloid Leukaemia is the most common leukaemia in children - True or False?

False - it accounts for 10-15% of cases

What is the most common leukaemia in children?

Acute Lymphoblastic Leukaemia

What are the risk factors for Acute Myeloid Leukaemia?

1) Increasing Age 2) Prior chemotherapy 3) Preceding haematological disorders 4) Exposure to ionising radiation

What is the treatment for Acute Myeloid Leukaemia?

1) Supportive care - blood products, infection treatment 2) Chemotherapy - curative or palliative 3) Bone marrow transplantation

Cure rates for Acute Myeloid leukaemia are relatively high for all ages - True or false?

False - cure rates are highest in children (60%) but low in older adults (20%)

In which age group is Chronic Myeloid Leukaemia most common?

40-60 years

What are the features of Chronic Myeloid Leukaemia?

1) Splenomegaly | 2) Metabolic features

What is done to diagnose Chronic Myeloid Leukaemia?

1) FBC - High WBC 2) Blood film - Left shift plus basophilia 3) Philadelphia chromosome

What is the treatment for Chronic Myeloid Leukaemia?

1) Molecular therapy - Tyrosine kinase inhibitors

The survival rate is high for Chronic Myeloid Leukaemia- True or False?

True - >90% survival at 5 years

What is the presentation of Acute Lymphoblastic Leukaemia?

1) Bone marrow failure | 2) Organ infiltration - particularly the CNS

What does the presence of the Philadelphia chromosome in Acute Lymphoblastic Leukaemia mean?

Poor prognosis

What are the 4 stages of treatment for Acute Lymphoblastic Leukaemia?

1) Induction 2) Consolidation 3) Delayed intensification 4) Maintenance

The survival is poor for Acute Lymphoblastic Leukaemia, particularly in children - True or False?

False - The majority of children are cured as well as young adults, older adults typically 1/2 are cured

In addition to chemotherapy what other therapies are offered in Acute Lymphoblastic Leukaemia?

1) CNS directed therapy | 2) Stem cell transplantation

What happens to B lymphocytes in Chronic Lymphocytic Leukaemia?

They accumulate in the blood bone marrow and lymph glands

How is Chronic Lymphocytic Leukaemia usually diagnosed?

As an incidental finding on a blood screen

Chronic Lymphocytic Leukaemia is most common in the middle aged - True or False?

False - It is most common in the elderly

What happens as Chronic Lymphocytic Leukaemia progresses?

1) Lymphoadenopathy 2) Hepatospenomegaly 3) Haemolysis 4) Bone marrow failure 5) Hypogammaglobulinaemia 6) Infections

What treatments are done in Chronic Lymphocytic Leukaemia?

1) Sometimes nothing - watch and wait 2) Chemotherpy 3) Monoclonal antibodies 4) Target therapy - Burton kinase inhibitors 5) Bone marrow transplant

What is an autologous bone marrow transplant?

Bone marrow transplant from own bone marrow

What is bone marrow transplant from someone else called?

Allogenic

Which type of bone transplant - autologous or allogenic is safer?

Autologous - it is from the patients own body therefore less likely to be rejected

What is the most common form of leukaemia?

Chronic Lymphocytic Leukaemia