Hematology/Oncology (WBC,s) Flashcards

Question

What can be the complictions for treatment of ALL?

Answer 1

``` Chemotherapy given (drugs) can cause the Tumor lysis syndrome. Direct testicular radiation can lower sperm count and cause infertility (so sperm donation and preservation should be suggested) Intrathecal methotrexate and cranial irradiation can lead to cognitive disfunction ```

Answer 2

Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream A lot of cell killed at the same time--> high K+ and Phosphate and uric acid released in blood stream from the lysis cell---> bad for blood-----> kidney overworks to remove these substances-----> renal failiure

Answer 3

MDS is the intermediate gateway between the normal state and the AML (almost 30% cases of MDS convert to AML) here hypercellular bone marrow is seen (not similar to aplastic anaemia in which pancytopenia is due to hypocellular BM) dysplasia means pre cancerous the whole reason for treatment is to prevent the MDS to convert to AML Myelodysplastic syndrome is not the same as myeloproliferative disorders Both are Myeloid lineage but in Myeloproliferative there is no cytopenia and there is adequate maturation in MDS there is cytopenia and inadequate maturation

Answer 4

MDS is the stem cell disorder with ineffective haematopoesis, defect in maturation of cell of myeloid lineage (this include rbc. Granulocytes,wbc and platelets, this is why we will have pancytopenia MCV will be high because immature cells It is acquired clonal disorder affecting stem cells causes can be acquired or environmental

Answer 5

1) Refractory Anaemia (Slowest subtype to progres to AML) refractory anaemia- anemia inresponsive to treatment 2) Refractory Anaemia with ringed Sideroblasts 3) Chronic myelomonocytic 4) refractory anaemia with Excess blasts in transformation (fastest subtype to get converted into AML) Unfavorable cases- high % of blasts (in acute leukemias >20% and in MDS<20% so if the number of blasts is increasing you are getting close to getting cancer/leukemia) high no. Of cytopenias high age cytogenetic anomalies (chr 7) Favourable cases- 5q (in females) or 20q deletion

Answer 6

Supportive therapy human growth factors CHEMO stem cell transplant (last resort)

Answer 7

``` Mature cells older patients non existent or very few blasts cell (less than 10% in BM) small cells onset is insidious ``` risk factor - ionising radiation in high doses usually 40-60 years age 15% of adult leukemias

Answer 8

T(9:22) translocation of the proto-oncogen "ABL" ABL fuses with the Break cluster region (BCR) on ch 22 ABL(chr 9) + BCR (chr 22) ==> BCR-ABL fusion gene (on chr 22) this is called the Philadelphia Chromosome this philadelphia chromosome can lead to ALL or CML BCR-ABL fusion gene-----.translation-----> BCR-ABL protien 100% of patients with CML have philadelphia chromosome nut it is not specific because phil. Chr is also present in pattients with ALL this protien form is a tyrosine kinase (all enzymes are protiens) this tyrosine kinase will dirupt the cell function and will cause increased proliferation and decreased apoptosis this is why we treat this with tyrosine kinase inhibitor IMATINIB

Answer 9

Chronic phase (most patiens are diagnosed here) asymtomatic or mild symptoms accelarated phase - splenomegaly , basophilia , more immature cells are seen Blast crisis - clinically it starts to behave like an acute leukemia transfers to AML(70%) or ALL(30%)

Answer 10

A leukocyte alkaline phosphatase (LAP) test is a laboratory test that can be conducted on a sample of your blood. Your doctor can order it to measure the amount of alkaline phosphatase, a group of enzymes, in certain white blood cells. Leukocyte alkaline phosphatase (LAP) is the term for alkaline phosphatase that’s found in leukocytes. Another name for leukocytes is white blood cells. When your test results are available, your doctor will discuss them with you. They will help you understand what the results mean and discuss follow-up steps. Scores for the LAP test can range from zero to 400, with those between 20 and 100 being considered normal. A score that’s higher than normal may be caused by: leukemoid reaction essential thrombocytosis myelofibrosis polycythemia vera A score that’s lower than normal may indicate: CML (because leukemic cells are useless) aplastic anemia pernicious anemia If your doctor suspects you may have CML based on your test results, they will likely order a cytogenetic test. This will help them confirm their diagnosis.

Answer 11

A phase of chronic myelogenous leukemia in which tiredness, fever, and an enlarged spleen occur during the blastic phase, when more than 30% of the cells in the blood or bone marrow are blast cells (immature blood cells). CML coverts to AML and behave like it increased Basophilia is aldo seen

Answer 12

It is a benign condition It is an exaggerated responseof leucocytes against a microbial pathogen or response to stress WBC> 50,000 could be wither Myeloid or Lymphoid origin

Answer 13

Both wil have basophilia However the LAP score is low in CML (the leucocytes are useless but high) and high in leukemmoid recation (exaggerated response)

Answer 14

Alkaline- Stable and works in Alkaline environment (basic) phosphatase- an enzyme that removes phosphate group from a molecule (Kinase adds a phosphate group :) do not confuse it with Acid phosphatase that works best in acidic environment

Answer 15

In B-ALL it is negative | T-aLL positive

Answer 16

Hepatobilliary and musculoskeletal system. ALP is high in case of- ``` hepatobilliary diseases hepatic cirrgoiss leukemoid rxn (also LAP high) Paget disease osteomylasia hyperthyroidism/parathyroid pregnancy ``` ALP will be low in- wilson disease PNH CML hypothyroidism and menopause

Answer 17

Enxyme removing the Phosphate group in an basic environment in Mature Leucocytes

Answer 18

Even though in CML the cells of the myeloid lineage is mature but it is cancer and in cancer we have a left shift. These cells would no be as mature as normal cells in leukemoid rxn the cells are fully mature and functional so high LAP LAP high in leukemoid rxn polycythemia vera low in- CML Apastic anaemia (because of pancytopenia) pernicious anaemia

Answer 19

Tyrosine kinase adds phophate group (ON-OFF switch) It takes Phosphate group from ATP and gives it to a protien Now the Tki,s Blocks the ATP binding site on the tyrosine kinase enzyme so no phosphate tranfer to the protien now for Imatinib the target protiens are different like in CML -- BCR-ABL protien These are teratogenic in nature so not given in pregnancy.

Answer 20

We use TKI's 1) First Generation- Imatinib (all phases) 2) Second generation- Dasatinib (all phases), Nilotinib (cannot give in case of blast crisis), Bosutinib (never the first choice) 3) third- Ponatinib we can also give Omacetaxine that is a more selective on BCR-ABL (after 2 or more TKI's have failed)

Answer 21

Leukostasis happens because of high number of blasts in the blood high viscosity= low tisseue perfusion that can lead to stroke cerebral ischemia haemorrhage sludge in pulmonary vessels-pulmonary effusion DIC tumor lysis syndrome because its blasts cell it is realted to AML, ALL and CML(in case of blast crisis)

Answer 22

Give hydroxyurea (in tumor lysis syndrome) leukopharesis (to remove the blast cells) Induction chemotherapy Prophylaxis for tumor lysis syndrome by giving hydrate the patient and give allupurinol, rasburicase. Brain radiation

Answer 23

Lymphoproliferative disorder of high no of mature lookinf lymphocytes (that are of no use or incompetant0 If there is a solid lymph nodal mass (as lymphocyte goes to mature in lymph nodes) we will call it SLL CLL/SLL as leukemia can lead to lymphoma and vice versa Elderly caucasian male usually asymptomatic lymphocytosis (smudge cells seen) lymphadenopathy hepato splenomegaly anaemia and thrombocytopenia is seen (n severe cases)

Answer 24

Stage 0 lymphocytosis with smudge cell risk low Stage 1 lymphocytosis+adenopathy medium Stage 2 lymphocytosis + hepatosplenomegaly mid Stage 3 Anaemia high Stage 4 thrombocytopenia high

Answer 25

Yes | 10% of the people with CLL will have diffuse large cell lymphoma (aggressive form)

Answer 26

Rare Indolent (not aggressive,mild) some say it is a subtype of CLL Hairy cells ----> Mature B lymphocytes Leukemic cell accumulate in the spleen Leukemic cell will overcrowd other cell lines causing anaemia, leukopenia and thrombocytopenia high risk for people who do farming and gardening good prognosis tretament- supportive therapy purine analogs (metabolites that mimic sttructure of purines) - Cladribine and pentostatin BRAF inhibitors

Answer 27

Leukemia itself can also cause anemia. As leukemia blood cells multiply rapidly, little room is left for normal red blood cells to develop. If your red blood cell counts drop too low, anemia can occur

Answer 28

Airway Obstruction | Superior vena cava syndrome

Answer 29

Some lymphomas can create IgM antibodies that can cause hv syndrome