Haematology

Question 1

Features of leukaemia

Answer 1

Very high white blood cell count, low red blood cell

Question 2

What is leukaemia?

Answer 2

Cancer of the bone marrow
Proliferation of early progenitor cells that do not mature, replace normal bone marrow cells.
Can be either myeloid or lymphoid.

Question 3

What are myeloproliferative neoplasms?

Answer 3

Proliferation of RBC, platelet or white blood cell lineage.

Cells mature as normal but proliferate abnormally.

Question 4

Example of myeloproliferative neoplasm?

Answer 4

Polycythaemia

Question 5

What are lymphomas?

Answer 5

Cancer of lymphoid tissue (lymph nodes)
Abnormal lymphocyte (B, T cell) proliferation
Present with enlarged lymph nodes.

Question 6

What is myeloma?

Answer 6

Cancer of plasma cells (mature B cells following antigen exposure) producing a monoclonal immunoglobulin.
Plasma cells produce cytokines that cause lysis of bone.

Question 7

What is chronic myeloid leukaemia?

Answer 7

Dysregulated production and uncontrolled proliferation of mature granulocytes

Question 8

What is chronic lymphoid leukaemia?

Answer 8

Proliferation of mature B lymphocytes
Most common in patients age 70+
As disease progresses lymph nodes may enlarge as in lymphoma

Question 9

What is the epidemiology of acute leukaemia?

Answer 9

AML: More common in adults

ALL: more common in children

Question 10

What are the 3 clinical presentations of acute leukaemia?

Answer 10

Anaemia: Fatigue, Dyspnoea, Chest pain
Neutropenia: persistent infection, slow healing wounds
Thrombocytopenia: easy bruising and bleeding

Question 11

What are the diagnostic tests involved with leukaemia?

Answer 11

Full blood count
Low haemaglobin
Increased white blood cells
Severely low platelet count

Question 12

What are the two forms of bone marrow biopsy?

Answer 12

Aspirate: liquid portion of bone marrow
Trephine: portion of bone marrow removed

Question 13

What are the 4 causes of leukaemia?

Answer 13

1. Congenital/inherited risk factors
   - patients with down syndrome at increased risk of leukaemia
2. Viral infections
3. Radiation
4. Chemical/DNA damaging drugs
   - patients taking chemo for another cancer increases risk of leukaemia

Question 14

What are the stages of leukaemia treatment?

Answer 14

Multi-agent Chemotherapy

Induction therapy: induce remission

Consolidation: to mop up residual leukaemia

Maintenance: keep patient in remission

Question 15

When would we consider stem cell therapy for a patient with leukaemia?

Answer 15

Considered in first or second remission.
Depends on
- age of patient
- donor availability
- risk of relapse

Question 16

What is the Philadelphia Chromosome?

Answer 16

Interchange of chromosomal data from 22 (BCR) and 9 (ABL) in the bone marrow. Causes the formation of BCR-ABL fusion gene.

Question 17

What are the clinical features of CML?

Answer 17

Enlarged lymph nodes
Enlarged spleen, which is a consequence of high WBC count
Fatigue
Anorexia
Weight loss

Question 18

What is the mainstay of treatment for CML?

Answer 18

Target BCR-ABL gene - Imatinib
Inhibits BCR-ABL tyrosine kinase, blocks proliferation and induces apoptosis in BCR-ABL cell lines in Philadelphia chromosome positive CML.

Question 19

What are the clinical features of Hodgkin lymphoma?

Answer 19

Painless, enlarged lymph nodes above diaphragm

“B symptoms”
Fever
Weight loss
Night sweats

Question 20

What are the stages of Hodgkin Lymphoma?

Answer 20

Identified with CXR, CT and PET scan of chest, abdomen and pelvis.

Stage 1: one nodal group

Stage 2: >1 nodal group on the same side of diaphragm

Stage 3: bilateral nodal groups

Stage 4: extranodal

Question 21

What are the treatment options for Hodgkin lymphoma?

Answer 21

Chemotherapy

• ABVD: initial treatment for newly diagnosed Hodgkin lymphoma
• BEACOPP: stage >II

Radiotherapy

Question 22

What to consider before beginning treatment for Hodgkin lymphoma?

Answer 22

Fertility
Secondary cancer
Coronary artery disease
Drug toxicity

Question 23

What is the clinical presentation of Non-Hodgkin Lymphoma?

Answer 23

Enlarged lymph nodes

Extranodal

Question 24

What is the usual treatment for NH Lymphoma?

Answer 24

Chemotherapy + Monoclonal Antibody

Question 25

What is the clinical presentation of multiple myeloma?

Answer 25

Paraprotein or M band (increase in immunoglobulin)

Plasma cell infiltration of bone marrow

Bone lesions

Question 26

What are diagnostic tests used to confirm multiple myeloma?

Answer 26

Blood tests
Bone marrow biopsy
Xray, MRI, CT scan

Question 27

What are the treatment options for multiple myeloma?

Answer 27

Younger patients: chemotherapy with stem cell transplant

Older patients: chemotherapy, maybe novel agent (thalidomide, mAbs)