intro to hematological malignancies

Question 1

What are hematopoietic malignancies

Answer 1

Clonal dx that are derived from a single cell in the marrow or peripheral lymphoid tissue that has undergone genetic alteration

Question 2

percentage of hematologic cancers

Answer 2

7%

Question 3

Risks for developing malignancy

Answer 3

Genetic inheritance

Environmental factors

Question 4

Inherited factors causing malignancy

Answer 4

Downs syndrome
Blooms syndrome
Fanconis anemia
Neurofibromatosis
Klinefelters syndrome
Familial tendency

Question 5

Environmental factors that cause malignancy

Answer 5

Chemicals
Drugs
radiation
infection
viruses
bacteria
protozoa

Question 6

How are oncogenes or protooncogenes activated

Answer 6

through translocation, mutation, or duplication

Question 7

Oncogenes that suppress apoptosis

Answer 7

bcl-2

Question 8

Tyrosine kinases are important for

Answer 8

intracellular signaling

Question 9

Increasing tyrosine kinase activity found in the ff dx

Answer 9

CML-ABL
JAK-2 in myeloproliferative dx
FLT3 in AML
Bruton kinase in CLL
Lymphoproliferative disorders

Question 10

Plasma cell dyscrasias differentiated into

Answer 10

Plasma cell myeloma
Plasmacytoma
Waldestrom macroglobulinemia

Question 11

How de we take history in suspected hematological malignancy

Answer 11

Fever- persistent? intermittent? pel ebstein/
Jaundice
Excess pruritus and sweating
Chest pain and diffivulty in breathing
Bleeding
Recurrent infections

Question 12

Physical examination of hematological malignancies

Answer 12

Anemia-signs and symptoms

CNS signs and symptoms which imply CNS involvement. i.e confusion, aggressive behavior

Thrombocytopenia i.e ecchymosis, purpura

Organomegaly i.e splenomegaly, hepatomegaly

Lymph adenopathy i.e lymphomas

Plasmacytomas- may be seen as myeloma or plasma cell dyscrasias

Question 13

What to look for if suspecting leukemia

Answer 13

FBC and comment

Bone marrow aspirate for morphology, cytogenetics, etc

Trephine biopsy

Lumbar puncture; Csf needed for cytology

Chest radiography for mediastinal involvement

Abdominal ultrasonography fpr organomegaly

CT scan and MRI when needed

Question 14

What is immunophenotyping

Answer 14

Helps to categorize cells by their surface antigens using antibodies labelled with different fluorochromes

Question 15

B cell surface antigens include

Answer 15

CD19,20,22

Question 16

T cell surface antigens include

Answer 16

CD-3,5,7

Question 17

AML surface antigens include

Answer 17

CD 13,33,117

Question 18

What is immunohistochemistry

Answer 18

The prescence and architecture of tumour cells can be identified and visualised under a microscope in stained tissue sections using monoclonal antibodies

Question 19

Identification of chromosomal abnormalities is done by

Answer 19

Flourescent in situ hybridization - flourescent labelled genetic probes

Southern blot analysis -Extraction of DNA from leukemic cells

PCR - Detects translocations and gene rearrangements

Question 20

Principles of management of malignancies

Answer 20

Clinical diagnosis- physical exam and history
Lab diagnosis
Treatment

Question 21

Treatment of malignancies include

Answer 21

Specific - chemotherapy
Supportive - blood products
                      Antibiotics
                      Antimicrobials
                      Analgesics

Question 22

How to follow up for lymphomas

Answer 22

3-4 times weekly when on chemotherapy till 6-8 cycles of chemotherapy is done ( remission)

After this 3 times monthly

LDH useful

Question 23

How to follow up for leukemias

Answer 23

Weekly till patient is on remission

afterwards monthly for maintenance therapy

Question 24

How to follow up a plasma cell myeloma

Answer 24

3-4 times weekly when on iv chemotherapy till remission

Monthly for maintenance after that till plateau phase

Question 25

This is done for all haem malignancies

Answer 25

FBC