Haematology - Leukaemia

Question 1

What is leukaemia?

Answer 1

Cancer of the stem cells in the bone marrow

Leading to unregulated production of blood cells

Question 2

What are the different types of leukaemia that affect children?

Answer 2

Acute lymphoblastic leukaemia (most common)
Acute myeloid leukaemia
Chronic myeloid leukaemia

Question 3

At what ages does leukaemia peak?

Answer 3

Acute lymphoblastic leukaemia 2-3 years old

Acute myeloid leukaemia under 2

Question 4

Why does leukaemia lead to pancytopenia?

Answer 4

Mutation in precursor cells, leads to excessive production of abnormal white cells

Excessive production can lead to suppression of other cell lines leading to underproduction

Question 5

What is the main risk factor for leukaemia?

Answer 5

Radiation exposure e.g. abdo x-ray during pregnancy

Question 6

Why do you get pallor in leukaemia?

Answer 6

Anaemia

Question 6

How does leukaemia present?

Answer 6

Persistent fatigue
Unexplained fever
Failure to thrive
Weight loss
Night sweats
Pallor
Petechiae and abnormal bruising
Unexplained bleeding
Abdominal pain
Generalised lymphadenopathy
Unexplained or persistent bone or joint pain
Hepatosplenomegaly

Question 6

What conditions can predispose children to a higher risk of developing leukaemia?

Answer 6

Down’s syndrome
Kleinfelter syndrome
Noonan syndrome
Fanconi’s anaemia

Question 7

What causes petechiae and abnormal bruising?

Answer 7

Thrombocytopenia

Question 8

What does NICE recommend for any unexplained petechiae or hepatomegaly?

Answer 8

Immediate specialist assessment

If leukaemia is suspected, recommend urgent FBC within 48 hours

Question 9

What investigations are used to establish leukaemia diagnosis?

Answer 9

FBC, anaemia, leucopenia, thrombocytopenia and high WBCs
Blood film - blast cells
Bone marrow biopsy
Lymph node biopsy

Question 10

What tests may be needed for staging?

Answer 10

CXR
CT scan
LP
Genetic analysis and immunophenotyping of abnormal cells

Question 11

How is leukaemia managed?

Answer 11

Paediatric oncology MDT

Primary treatment is chemotherapy

Question 12

What other therapies may be used to treat leukaemia?

Answer 12

Radiotherapy
Bone marrow transplant
Surgery

Question 13

What are the complications of chemotherapy?

Answer 13

Failure to treat leukaemia
Stunted growth and development
Immunodeficiency and infections
Neurotoxicity
Infertility
Secondary malignancy
Cardiotoxicity

Question 14

What is the prognosis for leukaemia?

Answer 14

Cure rate for acute lymphoid leukaemia is 80%, depends on individual factors

Outcomes not as good in acute myeloid leukaemia