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Haematology and Immunology > Intro to Haematological Malignancies > Flashcards

Intro to Haematological Malignancies Flashcards

1
Q

Who does haematological malignancies affect?

A

All age groups, even children

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2
Q

Which gender of adult gets haematological malignancies more?

A

M > F

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3
Q

Pathology of haematological malignancies

A

Multi step process
Acquired genetic alterations to a long lived cell
Proliferative/survival advantage to that mutated cell (have to have a proliferative/survival advantage over the other cells to give it a malignant phenotype)
This produces a malignant clone
The malignant clone grows to dominate the tissue (e.g. bone marrow or lymph nodes)

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4
Q

Drivers of haematopoiesis

A

Multipotential haematopoietic stem cells

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5
Q

Features of multipotential haematopoietic stem cells

A

Can self renew

multipotential i.e. can produce all types of cells

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6
Q

Definition of haematopoiesis

A

Refers to the commitment and differentiation processes that lead to the formation of all blood cells from haematopoietic stem cells

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7
Q

Myeloid lineage of malignancies are called what?

A

Myeloid malignancies

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8
Q

Types of cells of myeloid malignancies

A

Red cells
Platelets
Granulocytes
Monocytes

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9
Q

Lymphoid lineage of malignancies are called what?

A

Lymphoid malignancies

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10
Q

Types of cells of lymphoid malignancies

A

B cells

T cells

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11
Q

What is the commonest malignancy of childhood?

A

Acute lymphoblastic leukaemia

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12
Q

Pathology of development of AML (acute myeloid leukaemia)

A

Genetic mutation in the stem cells
Early accumulate of myeloid progenitor cells which keep proliferating without maturing or differentiating -> bone marrow cells -> AML
so the bone marrow is stuffed with useless cells
No N cells in the blood

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13
Q

Pathology of the development of ALL (acute lymphoblastic leukaemia)

A

Genetic mutation in the stem cells
Ongoing proliferation at a slightly higher rate and an increase in differentiation
Accumulation of more N cells (red cells, neutrophils etc) in the blood
ALL

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14
Q

How do mature lymphoid malignancies (e.g. Hodgkin / non Hodgkin lymphoma) come about?

A

Mutations occur in a later place e.g. bone marrow, lymph node after already having ALL
Most likely occur in the germinal cell of the lymph node

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15
Q

Different mutations in the same stem cell compartment lead to what?

A

Different phenotypes

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16
Q

AML can lead to what?

A

Myeloproliferative disorders

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17
Q

What is the difference between leukaemia and lymphoma?

A

The distribution of the disease

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18
Q

Bone marrow malignancy is described as what?

A

Leukaemia

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19
Q

Lymphoma is found in what?

A

Lymph tissue or

Solid organs

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20
Q

Commonest form of leukaemia is what?

A

Chronic lymphocytic leukaemia

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21
Q

Features of chronic lymphocytic leukaemia

A

Perfectly well

Elderly usually

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22
Q

Features of Burkitt’s lymphoma / leukaemia

A

Most aggressive
commonly presents with lumps
Can affect young adults / children
Can be both lymphoma and leukaemia as it can present with both

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23
Q

Acute leukaemias

A

Acute lymphoblastic leukaemia (ALL)

Acute myeloid leukaemia (AML)

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24
Q

Chronic leukaemia s

A

Chronic myeloid leukaemias (CML)

Chronic lymphoid leukaemia (CLL)

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25
The malignant lymphomas
``` Non-Hodgkin Lymphoma (NHL) Hodgkin Lymphoma (HL) ```
26
What does MDS stand for?
Myelodysplastic syndromes
27
Acute vs chronic leukaemia name is related to what?
The pace of the disease
28
Pathology of acute leukaemia
Leukaemic cells do not differentiate Bone marrow failure over a short period of time Rapidly fatal if untreated - being well to very unwell to dead within weeks
29
Is acute leukaemia potentially curable?
Yes
30
Clinical features of acute leukaemia
``` Bone marrow failure - anaemia - thrombocytopenic bleeding (purpura and mucosal membrane bleeding) - infection because of neutropenia (predominately bacterial and fungal) as cant make puss so infections spread easier Bleeding - Petechial - GI - eye ```
31
What is the triad of symptoms of bone marrow failure?
Anaemia Thrombocytopenic bleeding (mucosal, purpura) Infection (because of neutropenia)
32
Pathology of chronic leukaemia
Leukaemic cells retain ability to differentiate Proliferation without bone marrow failure Very white blood
33
Survival of chronic leukaemia
Survival for a few years | Quite well for a long time
34
Is chronic leukaemia potentially curable?
Yes, with modern therapy
35
Bone marrow (aplasia) can fail for a number of reasons.....
Malignancies other conditions chemotherapy
36
Structure of a lymph node
``` Inner medulla Outer cortex Follicles dotted in lymph node - germinal centre (B cells mature here) - mantle zone (around germinal centre) - marginal zone (around mantle zone) ```
37
Where do B cells mature in the lymph node after coming from the bone marrow?
Germinal centre
38
Lymphomas commonly develop in what cells?
Mutations of the cells when in the germinal centre
39
Presentation of lymphoma
``` Nodal disease - lymphadenopathy Extra-nodal disease Systemic symptoms - fever - B symptom - drenching sweats - B symptom - loss of weight (10% of weight) - B symptom - pruritic - fatigue ```
40
What are the B symptoms?
Fever drenching sweats Loss of weight
41
What do people with B symptoms indicate?
A less favourable prognosis and may need more treatment
42
Nodal disease HL vs NHL
``` HL = > 90% present with nodal disease NHL = approx. 60% present with purely nodal disease ```
43
If lymphadenopathy is localised and painful - what does this indicate?
Bacterial infection in draining site
44
If lymphadenopathy is localised and painless, what does this indicate?
Rare infections, catch scratch fever, TB Metastatic carcinoma from draining site - HARD Lymphoma - RUBBERY reactive, no cause identified
45
If lymphadenopathy is generalised and painful/tender, what does this indicate?
``` Viral infections EBV CMV Hepatitis HIV ```
46
If lymphadenopathy is generalised and painless, what does this indicate?
``` Lymphoma Leukaemia Connective tissue diseases, sarcoidosis Reactive, no cause identified Drugs ```
47
What about a lymph node indicates a metastatic carcinoma from a draining site?
HARD
48
What about a lymph node indicates lymphoma?
RUBBERY
49
What is multiple myeloma?
Malignancy of the plasma cells in the bone marrow
50
What does multiple myeloma produce?
An abnormal immunoglobulin/antibody into the blood
51
Presentation of multiple myeloma
Bone pain Lytic lesions (destruction of skeleton by activation of osteoclasts - NOT sclerotic) Anaemia - renal failure - anaemia of chronic disease Recurrent infections Renal failure (an immunoglobulin blocking the renal tubule) Amyloidosis (deposition of chains in other tissues e.g. kidneys) Bleeding tendency Hyper viscosity syndrome (malignant cells producing huge amounts of paraproteins)
52
Causes of thrombocytosis
``` infections post surgery / trauma malignancy iron deficiency inflammation - IBD / RA primary myeloproliferative disorder ```
53
Presentation of myelofibrosis
``` Splenomegaly (can be massive) Cytopenia symptoms Spleen symptoms Weight loss Extreme tiredness Leukoerythroblastic blood film, teardrop red cells Marrow fibrosis - reticulin stain ```
54
Mutations common in myelofibrosis
JAK2 CALR MPL
55
What happens in myelofibrosis?
The bone marrow is replaced by fibrous (scar) tissue
56
Possible causes of lymphocytosis
``` Viral infection (e.g. EBV, HIV) other infections e.g. TB, syphilis Vasculitis Acute lymphoblastic leukaemia Chronic lymphocytic leukaemia Lymphoma ```
57
Treatment of neutropenia (if risk factors)
Filgrastim (as brings up neutrophil count more quickly in those at high risk)
58
What is filgrastim?
Granulocyte colony stimulating factor
59
Examples of patients at high risk for febrile neutropenia
Elderly Specific malignancies (e.g. NHL, ALL) Previous neutropenic episodes Those receiving combination chemo and radio
60
What is checked before each round of chemo and why?
Neutrophil levels | As if neutropenia, increased risk of developing an infection or neutropenic sepsis

Haematology and Immunology (18 decks)

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