Haematology and Oncology Flashcards
What are the development lines for myeloid stem cell and lymphoid stem cell.
Lymphoid: - Lymphoblast- T lymphocyte, NK cells and B lymphocyte (B lymphocyte goes to plasma cell)
Myeloid:
- RBC, Platelets, Myeloblast
- Myeloblast: goes to granulocytes: Basophil, eosinophil, neutrophil.
Describe acute leukaemia.
What are the three resulting complications of bone marrow failure.
- Neoplastic condition with rapid onset
- Characterised by presence of immature cells (blasts) in blood and bone marrow.
- Anaemia: fatigue, pallor, breathlessness
- Neutropenia: recurrent infections
- Thrombocytopenia: bleeding and easy bruising.
Give 4 risk factors for Acute Myeloid leukaemia.
What is found in blood film for diagnosis?
- Down’s, irradiation, increased age, anti-cancer drugs.
- Auer rods in myeloblasts.
What is progression of promyelocytic leukaemia? What condition is it associated with.
- Very aggressive subtype of AML
- Associated with DIC.
What demographic is Acute Lymphoblastic Leukaemia the most common cancer in?
Which type of ALL is the most common?
Give 3 sites of organ infiltration.
Why is wheeze present in T cell ALL?
- Commonest cancer of childhood, 75% are under 6.
- 75% is B cell ALL.
- Hepatosplenomegaly, enlarged lymph nodes, swollen testes.
- T cell ALL can get thymus mass -> mediastinal compression causes stridor, wheeze, superior vena cava obstruction.
What blood test result is present in ALL?
- What is seen on BM film?
- Raised WCC, low Hb, low platelets.
- >20% lymphoblasts on BM film
What occurs in chronic lymphocytic leukaemia?
What is seen on blood film?
What symptoms may occur?
What is seen on examination?
- Accumulation of mature incompetent lymphocytes unable to undergo apoptosis.
- Cells are fragile- will break when smeared on slide. Smear/ smudge cells seen.
- Sx of BM failure, recurrent infections, anaemia, easy bruising/ bleeding.
- Enlarged, non-tender lymphadenopathy, hepatosplenomegaly.
What occurs in chronic myeloid leukaemia?
Which chromosome is present in most CML? What gene is subsequently formed?
- Uncontrolled proliferation (myeloproliferative) of granulocyte precursors (not mature cells) in BM but slower progression than
AML. - Philadelphia chromosome in >80% of CML.
- Formation of BCR-ABL gene- constitutively active TK receptor- continuous cell proliferation.
Give 4 categories of symptoms in CML.
- 50% are asymptomatic
- Massive splenomegaly in 90%
- Hypermetabolic symptoms: weight loss, malaise, sweating.
- BM failure Sx: lethargy, dyspnoea, easy bruising/ epistaxis.
- Hyperviscosity Sx: visual disturbance, headache, thrombotic event.
- Gout
Give 2 blood test findings in CML.
- Raised WCC often more than 100x10^9.
- No excess blasts if diagnosed at chronic stage
Can transform into accelerated or acute phase.
What is Hodgkin’s lymphoma?
- What are the bimodal age peaks?
- 50% of cases associated with which virus?
- Malignant proliferation of lymphocytes accumulating in lymph nodes causing lymphadenopathy.
- 20-30 and >50
- Associated with EBV.
Give the presentation of Hodgkin’s lymphoma.
What cells are found in lymph node biopsy?
What staging type is used?
- Painless, enlarging mass often in neck (possible axilla or groin). Becomes painful after alcohol ingestion.
- Reed Sternberg cells- aka Owl’s eyes
- Ann Arbour staging.
What is Non-Hodgkin’s lymphoma?
- What is percentage distribution between B Cell and T cells.
- Which conditions is it associated with?
- How does incidence change with age.
- Malignancy of lymphoid cells originating in LNs without Reed Sternberg cells.
- 85% B cell, 15% T cell and NK cell.
- EBV, HIV, SLE, Sjorgen’s.
- Incidence increases with age.
Give the presentation of Non-Hodgkin’s lymphoma.
Give 5 signs of organ involvement.
What other signs may be seen?
Which staging is used?
- Painless enlarging mass in neck, axilla or groin.
- Skin rashes, headache, hepatosplenomegal, sore throat,
cough. - Systemic signs (FLAWS) or signs of BM failure.
- Ann Arbour staging.
Give 3 features of Burkitt’s lymphoma.
Subtype of NHL- B cell.
- African child
- Large LN in jaw, fast growing
- Starry sky appearance under microscopy.
What 2 things is multiple myeloma characterised by?
What is racial demographic likelihoods.
- Proliferation of plasma cells (specialised B cells) and production of monoclonal immunoglobulin (IgG or A).
- Afrocaribbean> Caucasians> Asians.
What is the acronym for complications of multiple myeloma?
CRABI
- Calcium- high: tired, thirsty, polyuria, nausea, constipation.
- Renal impairment: Ig and fragments deposit in kidney
- Anaemia (+ neutropenia, thrombocytopenia) due to marrow infiltration by plasma cells.
- Bone pain/ lesions: increased osteoclast activation due to myeloma cell signalling: back and rib pain
- Infection: Recurrent bacterial due to low levels of other Ig.
What is Monoclonal Gammopathy of Unknown Significance (MGUS)?
How does it differ from multiple myeloma?
- Pre-malignant accumulation of some monoclonal plasma cells.
- 1% require additional mutations to develop Multiple myeloma
- ABSENT CRABI features.
Multiple myeloma: - What is found in serum/ urine electrophoresis? - What is serum Ca and ALP? - What serum protein is seen? - What is seen in blood film? What is found in BM aspirate?
- Bence jones proteins in urine
- Raised Ca, normal ALP- ALP is raised in malignancy
- Serum monoclonal protein >30 g/L
- Rouleaux formation in blood film: flattened RBCs stack.
- Raised plasma cells in BM aspirate.
Which coagulation pathway is measured by APTT?
Which is measured by PT?
Give numerical sequence of intrinsic pathway.
Give sequence of extrinsic pathway.
- Intrinsic pathway: APTT.
- Extrinsic pathway: PT.
Intrinsic: 12, 11, 9 (8), 10 (5), 2, 1 (13), cross linking fibrin
Extrinsic: Tissue factor, 7- 7a, 7a sits 9a (i.e. 7 is extrinsic version of 8)
What is the inheritance of Haemophilia?
- Which factors are deficient in A and B?
Give 4 presenting symptoms of haemophilia.
- X linked recessive: typically affects boys.
- Haemophilia A: factor 8 deficiency, more common. B is 9 deficiency.
- Haemarthrosis after minimal trauma: swollen painful joint
- Haematomas: painful bleeding into muscles (can cause compartment syndrome).
- Excessive bruising/ bleeding
- Haematuria.
What 2 investigations are used to diagnose haemophilia?
- Prolonged APTT (intrinsic pathway), factor assay confirms diagnosis.
What is difference between types 1-3 of von Willebrand disease? What is the inheritance pattern of each?
- Type 1: reduced levels of normal vWF (AD)
- Type 2: defective vWF (AD)
- Type 3: complete lack of vWF and highly reduced factor 8 (AR)
Give 4 presenting features of von Willebrand disease.
What happens to APTT and PT times?
- More superficial bleeding than haemophilias
- Bruising, epistaxis, menorrhagia
- Increased gum bleeding post tooth extraction
- Prolonged bleeding from minor wounds.
- Raised APTT and normal PT.
