Leukaemia Flashcards
what is leukaemia?
cancer of a particular line of stem cells in the bone marrow
causes unregulated production of certain types of blood cells
how can leukaemia be classified?
how fast they progress - acute/chronic cell type affected - myeloid/lymphoid results in 4 types - chronic lymphocytic leukaemia - acute lymphoblastic leukaemia - chronic myeloid leukaemia - acute myeloid leukaemia
pathophysiology of leukaemia (why does it cause in issue basically)?
mutation in one of the precursor cells in the bone marrow leads to excessive production of that single type of abnormal white cell
excessive production of that white cell leads to suppression of the other cell lines causing underproduction of other cell types = pancytopaenia (low RBC, WBCs and platelets)
mnemonic to remember age of onset for 4 leukaemia types from youngest to oldest?
ALL CeLLmates have CoMmon AMbitions
- ALL (under 5)
- CLL (over 55)
- CML (over 65)
- AML (over 75)
general symptoms of leukaemia?
fatigue fever failure to thrive pallor (anaemia) petechiae/abnormal bruising/abnormal bleeding (thrombocytopaenia) lymphadenopathy hepatosplenomegaly
how is suspected leukaemia investigated?
FBC blood film LDH (often raised in leukaemia but not specific) bone marrow biopsy CXR lymph node biopsy lumbar puncture CT/MRI/PET scan
what is CLL?
chronic proliferation of single type of lymphocyte (usually B cell)
blood characteristics of CLL?
lymphocytosis
smudge cells on blood film
symptoms of CLL?
usually asymptomatic at presentation
can cause general features of leukaemia
risk of progression in CLL?
can transform into a high grade lymphoma called “richters transformation”
most common malignancy in children?
ALL
what is ALL?
malignant change in one of the lymphocyte precursor cells causing acute (rather than chronic) proliferation of single type of lymphocyte (usually B cell)
why is ALL more acutely problematic than CLL?
acute proliferation causes the proliferating B cells to replace other cell types being created in the bone marrow leading to pancytopaenia
what does blood film show in ALL?
blast cells
what syndrome is ALL associated with?
down syndrome
how does ALL present?
both acute leukaemias present with triad of bone marrow failure
- anaemia (pallor/ lethargy etc)
- neutropaenia (infections)
- thrombocytopaenia (bruising, bleeding etc)
can also have organ infiltration (bone pain, lymphadenopathy, hepatosplenomegaly)
can also have CNS infiltration (CN palsy)
mortality in ALL?
most cases are cured with chemo +/- stem cell transplant
what is CML?
chronic accumulation of myeloid cells in the bone marrow and blood
what genetic mutation causes CML?
philedelphia chromosome (balanced 9:22 translocation)
age of onset of CML?
can be any age but generally middle aged
3 phases of CML?
chronic phase
accelerated phase
blast phase
(most people present in the chronic phase)
describe chronic phase of CML?
can last around 5 years
often asymptomatic
immunocompetent but have high neutrophils and sometimes basophils (bc they have myeloid lineage)
describe accelerated phase of CML?
patients become more symptomatic
develop anaemia, thrombocytopaenia and become immunocompromised (low lymphocytes? bc myeloid cells taking up room?)
abnormal blast cells take up large proportion of cells in bone marrow (20%)
describe blast phase of CML?
severe symptoms of pancytopaenia
even higher proportion of bone marrow taken up by blast cells (30%)
often fatal
what is AML?
acute proliferation of myeloid lineage cells
different types of AML exist with cytogenic differences and differences in presentation
most common leukaemia in middle age?
AML
AML can be the result of transformation from what other conditions?
myeloproliferative disorders such as polycythaemia vera or myelofibrosis
risk factors for AML?
previous radiotherapy
exposure to benzene
down syndrome??
how does AML present?
presents acutely and progresses rapidly triad of bone marrow failure - anaemia - neutropaenia - thrombocytopaenia blast cells can accumulate in lymph nodes, liver and spleen causing lymphadenopathy and hepatosplenomegaly
features of AML on bone marrow biopsy?
at least 30% occupied by blast cells
AML blood film?
auer rods (within cytoplasm of blast cells) high proportion of blast cells (>30%)
how is AML managed?
chemo
bone marrow transplant depending on type of disease present
most common leukaemia in children (buzzwordy)?
ALL
leukaemia associated with down syndrome (buzzword)?
ALL
most common leukaemia in adults overall (buzzwordy)?
CLL
which leukaemia has 3 phases?
CML
which leukaemia can be result of transformation from myeloproliferative disorder?
AML
which leukaemia is associated with warm autoimmune haemolytic anaemia?
CLL
which leukaemia is associated with auer rods?
AML
which leukaemia is associated with richters transformation into high grade lymphoma?
CLL
which leukaemia is associated with smudge cells?
CLL
which leukaemia is associated with philadelphia chromosome?
CML
most common acute leukaemia in adults?
AML
