Haematology PAS Flashcards
What are the Principal subtypes of leukaemia
Acute: Acute lymphoblastic leukaemia (ALL),
Acute myeloid leukaemia (AML).
Chronic:
Chronic lymphocytic leukaemia (CLL), Chronic myeloid leukaemia (CML)
What is the approach to a patient with Leukocytosis?
Review smear (are abnormal cells present?) and obtain differential count.
What is the approach to patients with complaints of non-specific confusion/drowsiness?
do blood
cultures, FBC, U&E, LFT, Ca2+
, glucose, and clotting. Consider CNS bleeding—CT if in
doubt.
Explain neutropenic regimen ?
- Full barrier nursing in a side room and hand wash.
*Avoid IM injections. - Look for infection and Take swabs.
*blood ≈3—peripherally
± Hickman line
*Check vital signs 4-hrly
*Wash perineum after defecation
*Oral Candida and other infections prophylaxis are important.
What is the risk and management of of Hyperviscocity syndrome ?
leukostasis in heart, vessels and leukocytic thrombi in brain and other organs.
TX is hydroxycarbamide or leukapheresis.
Definition of DIC ?
DIC is defined as the release of procoagulants into the circulation causing widespread activation of coagulation, consuming clotting factors and platelets and increasing risk of
bleeding.
Signs of DIC ?
Bruising, bleeding, renal failure.
Laboratory markers of DIC ?
*Decreased Platelets
* Prolongation of PT; APTT due to consumption of coagulation factors.
* Decreased fibrinogen (correlates with severity)
*Increased fibrin degradation products (D-dimers).
Histology of DIC ?
*schistocytes
Treatment of DIC ?
- Replace platelets to overcome thrombocytopenia.
/L - cryoprecipitate to replace fibrinogen.
*FFP to replace coagulation factors
The commonest leukaemia with highest risk of DIC is acute pro myelocytic leukaemia: How is it treated?
all-transretinoic
acid (ATRA)
How to prevent sepsis in Leukaemia?
*Fluoroquinolone (eg ciprofl oxacin) before neutropenia gets
serious.
*Granulocyte colony stimulators (G-CSF) can increase the production of WBCs
(granulocytes) Careful during Chemotherapy.
*Herpes, pneumocystis, and CMV prophylaxis
Definition of Acute Lymphoblastic Leukaemia ?
A malignancy of lymphoid cells, affecting B- or T-lymphocyte cell lineages, arresting
maturation and promoting uncontrolled proliferation of immature blast cells, with
marrow failure and tissue infiltration
Risk factor for Acute Lymphoblastic Leukaemia ?
- Ionizing radiation during pregnancy.
*Down’s syndrome
The most common paediatric leukaemia ?
Acute Lymphoblastic Leukaemia ( CNS involvement is common)
Morphological classification of ALL?
L1, L2 and L3
L1 type ALL histology
Small
blasts with scanty cytoplasm
Histology of L2 subtype ALL?
Larger
blast cells with greater morphological variation and more abundant cytoplasm.
Histology of L3 subtype ALL?
Blasts with vacuolated basophilic cytoplasm.
What are the immunological classification of ALL?
Surface markers are used to classify ALL into:
*Precursor B-cell ALL
* T-cell ALL
* B-cell ALL.
What is the utility of cytogenic or chromosomal analysis based classification of ALL ?
To predict disease prognosis and recurrence.
Signs and symptoms of acute Lymphoblastic Leukaemia ?
- Marrow failure: anaemia (<Hb), Infection (< WBC), Bleeding (<platelets)
*Infiltration: Heapato and or splenomegaly, Lymphadenopathy, orchidomegaly. - CNS involvement: cranial nerve palsies and meningism.
Common infections in ALL?
*Bacterial septicaemia,
*zoster, CMV, measles,
*candidiasis, Pneumocystis pneumonia
Lab test in ALL are
- CBC look for blast cells and WBC count.
- CXR and CT chest to rule out mediastinal lymphadenopathy.
- LP to look for CNS involvement.