Haematology Flashcards
Features of leukaemia
Very high white blood cell count, low red blood cell
What is leukaemia?
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.
What are myeloproliferative neoplasms?
Proliferation of RBC, platelet or white blood cell lineage.
Cells mature as normal but proliferate abnormally.
Example of myeloproliferative neoplasm?
Polycythaemia
What are lymphomas?
Cancer of lymphoid tissue (lymph nodes)
Abnormal lymphocyte (B, T cell) proliferation
Present with enlarged lymph nodes.
What is myeloma?
Cancer of plasma cells (mature B cells following antigen exposure) producing a monoclonal immunoglobulin.
Plasma cells produce cytokines that cause lysis of bone.
What is chronic myeloid leukaemia?
Dysregulated production and uncontrolled proliferation of mature granulocytes
What is chronic lymphoid leukaemia?
Proliferation of mature B lymphocytes
Most common in patients age 70+
As disease progresses lymph nodes may enlarge as in lymphoma
What is the epidemiology of acute leukaemia?
AML: More common in adults
ALL: more common in children
What are the 3 clinical presentations of acute leukaemia?
Anaemia: Fatigue, Dyspnoea, Chest pain
Neutropenia: persistent infection, slow healing wounds
Thrombocytopenia: easy bruising and bleeding
What are the diagnostic tests involved with leukaemia?
Full blood count
Low haemaglobin
Increased white blood cells
Severely low platelet count
What are the two forms of bone marrow biopsy?
Aspirate: liquid portion of bone marrow
Trephine: portion of bone marrow removed
What are the 4 causes of leukaemia?
- Congenital/inherited risk factors
- patients with down syndrome at increased risk of leukaemia - Viral infections
- Radiation
- Chemical/DNA damaging drugs
- patients taking chemo for another cancer increases risk of leukaemia
What are the stages of leukaemia treatment?
Multi-agent Chemotherapy
Induction therapy: induce remission
Consolidation: to mop up residual leukaemia
Maintenance: keep patient in remission
When would we consider stem cell therapy for a patient with leukaemia?
Considered in first or second remission. Depends on - age of patient - donor availability - risk of relapse
What is the Philadelphia Chromosome?
Interchange of chromosomal data from 22 (BCR) and 9 (ABL) in the bone marrow. Causes the formation of BCR-ABL fusion gene.
What are the clinical features of CML?
Enlarged lymph nodes Enlarged spleen, which is a consequence of high WBC count Fatigue Anorexia Weight loss
What is the mainstay of treatment for CML?
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.
What are the clinical features of Hodgkin lymphoma?
Painless, enlarged lymph nodes above diaphragm
“B symptoms”
Fever
Weight loss
Night sweats
What are the stages of Hodgkin Lymphoma?
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
What are the treatment options for Hodgkin lymphoma?
Chemotherapy
- ABVD: initial treatment for newly diagnosed Hodgkin lymphoma
- BEACOPP: stage >II
Radiotherapy
What to consider before beginning treatment for Hodgkin lymphoma?
Fertility
Secondary cancer
Coronary artery disease
Drug toxicity
What is the clinical presentation of Non-Hodgkin Lymphoma?
Enlarged lymph nodes
Extranodal
What is the usual treatment for NH Lymphoma?
Chemotherapy + Monoclonal Antibody
What is the clinical presentation of multiple myeloma?
Paraprotein or M band (increase in immunoglobulin)
Plasma cell infiltration of bone marrow
Bone lesions
What are diagnostic tests used to confirm multiple myeloma?
Blood tests
Bone marrow biopsy
Xray, MRI, CT scan
What are the treatment options for multiple myeloma?
Younger patients: chemotherapy with stem cell transplant
Older patients: chemotherapy, maybe novel agent (thalidomide, mAbs)
