Leukaemia Flashcards

1
Q

Define Leukaemia

A

Progressive, malignant disease of the blood-forming organs, characterised by distorted proliferation and development of leukocytes and their precursors in the blood and bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference generally between acute and chronic leukaemias

A

Acute leukaemia = the haemopoietic cells lose their ability to differentiate/mature into the end cells, remaining as precursor cells (blasts >20%)

Chronic leukaemia = the haemopoietic cells proliferate and differentiate but are non-functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the cell development lineage

A

Blood stem cell -> myeloid or lymphoid cell

Myeloid: RBCs, platelets, granulocytes (neutrophils, eosinophils, basophils)

Lymphoid: B lymphocytes, T lymphocytes, Natural killer cells, plasma cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe Acute myeloid leukaemia

A

Most common acute leukaemia in adults

Myeloblasts, arrested at an early stage of development, undergo malignant transformation and proliferation -> replacement of normal bone marrow -> bone marrow failrue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe acute lymphoblastic leukaemia

A

Most common malignancy of childhood

Lymphoblasts (arrested at an early stage of development) undergo malignant transformation and proliferation →subsequent replacement of normal marrow → bone marrow failure and infiltration into other tissues

B lymphoblasts - B-ALL
T lymphoblasts - T-ALL

RF: radiation, viruses, Down’s, Fanconi’s anaemia, siblings with ALL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Symptoms and signs of Acute myeloid leukaemia

A

Anaemia → pallor, lethargy, SOB
Thrombocytopenia → bleeding, ecchymoses
Neutropenia → opportunistic, recurrent infection

Tissue infiltration:
Gum swelling/hypertrophy
CNS involvement (headaches, nausea, diplopia)
Skin rashes
Rare: deposits of leukaemic blasts in the eye, tongue and bone (fractures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of signs of acute lymphoblastic leukaemia

A

Bone marrow failure
Anaemia → pallor, lethargy, SOB
Thrombocytopenia → bleeding gums, bruising, menorrhagia
Neutropenia → opportunistic, recurrent infection
Meningeal involvement (headache, visual disturbance, nausea)

Tissue/organ infiltration 
Testicular swelling
Thymic swelling → Mediastinal compression 
Hepatosplenomegaly 
Lymphadenopathy 
Tender bones
Cranial nerve palsies 
Retinal haemorrhage or papilloedema, leukaemic infiltration of the anterior chamber of the eye
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe Chronic myeloid leukaemia

A

Chromosomal translation t(9,22) - Philadelphia Chromosome (fusion of genes BCR and ABL) -> malignant proliferation of stem cells

Male more common (4:1)

3 phases

  1. Relative stable chronic phase of variable duration (4-6 years)
  2. Accelerated phase (3-9 months)
  3. Acute leukaemia phase - blast formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms and signs of chronic myeloid leukaemia

A

50% asymptomatic - diagnosed on routine blood count

Systemic: weight loss, sweating
Bone marrow failure
- Anaemia → pallor, lethargy, SOB
- Thrombocytopenia → bleeding gums, bruising, menorrhagia
Abdominal discomfort, early satiety
Gout or hyperviscosity symptoms (headaches, visual disturbance, pruritus, worse after bath)
Blast crisis with symptoms of AML or ALL

Splenomegaly (90%)
Bone marrow failure → cardiac flow murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe chronic lymphocytic leukaemia

A

90% are >50, M>F

Cells are unable to apoptose

RF: haemolytic anaemia, thrombocytopenia, Evan’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms and signs of Chronic lymphocytic leukaemia

A

Asymptomatic (50%): diagnosed on routine blood count

Systemic: fatigue, night sweats
Bone marrow failure:
Recurrent infections, herpes zoster
Easy bruising/bleeding

Late stages: pallor, purpura/ecchymoses, cardiac flow murmur (bone marrow failure)
Lymphadenopathy
Hepatomegaly
Splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the characteristic findings on investigations for acute myeloid leukaemia

A

Blood films: Auer rods (large nucleocytoplasmic ratio and cytoplasmic inclusions) | AML blasts may show cytoplasmic granules
Immunohistochemistry: Myeloblast granules +ve for Sudan black staining

FBC: Anaemia | thrombocytopenia
Clotting: ?DIC

Bone marrow aspirate or biopsy: hypercellular >30% blasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the characteristic findings on investigations for acute lymphoblastic leukaemia

A

Blood film + TdT nuclear staining: Lymphoblasts | Postive TdT staining (positive in lymphoblasts, negative in lymphocytes and myeloblasts)

FBC: Anaemia | thrombocytopenia
CXR: mediastinal lymphadenopathy | thymic enlargement | lytic bone lesions

Bone marrow aspirate or biopsy: hypercellular >30% blasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the characteristic findings on investigations for chronic myeloid leukaemia

A

Blood film: Left shift | immature granulocytes
Cytogenetics: Philadelphia chromosome (t9:22)

FBC: raised WCC, basophils, neutrophils etc. | anaemia

Bone marrow aspirate or biopsy: hypercellular with raised myeloid: erythroid ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the characteristic findings on investigations for chronic lymphocytic anaemia

A

Blood film: smudge/smear cells | small lymphocytes

FBC: raised lymphocytes | anaemia | thrombocytopenia

Bone marrow aspirate/biopsy + immunophenotyping: lymphocytic replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly