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Year 4 > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

what is leukaemia?

A

cancer of a particular line of stem cells in the bone marrow

causes unregulated production of certain types of blood cells

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2
Q

how can leukaemia be classified?

A 
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
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3
Q

pathophysiology of leukaemia (why does it cause in issue basically)?

A

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)

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4
Q

mnemonic to remember age of onset for 4 leukaemia types from youngest to oldest?

A

ALL CeLLmates have CoMmon AMbitions

  • ALL (under 5)
  • CLL (over 55)
  • CML (over 65)
  • AML (over 75)
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5
Q

general symptoms of leukaemia?

A 
fatigue
fever
failure to thrive
pallor (anaemia)
petechiae/abnormal bruising/abnormal bleeding (thrombocytopaenia)
lymphadenopathy
hepatosplenomegaly
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6
Q

how is suspected leukaemia investigated?

A 
FBC
blood film
LDH (often raised in leukaemia but not specific)
bone marrow biopsy
CXR
lymph node biopsy
lumbar puncture
CT/MRI/PET scan
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7
Q

what is CLL?

A

chronic proliferation of single type of lymphocyte (usually B cell)

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8
Q

blood characteristics of CLL?

A

lymphocytosis

smudge cells on blood film

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9
Q

symptoms of CLL?

A

usually asymptomatic at presentation

can cause general features of leukaemia

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10
Q

risk of progression in CLL?

A

can transform into a high grade lymphoma called “richters transformation”

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11
Q

most common malignancy in children?

A

ALL

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12
Q

what is ALL?

A

malignant change in one of the lymphocyte precursor cells causing acute (rather than chronic) proliferation of single type of lymphocyte (usually B cell)

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13
Q

why is ALL more acutely problematic than CLL?

A

acute proliferation causes the proliferating B cells to replace other cell types being created in the bone marrow leading to pancytopaenia

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14
Q

what does blood film show in ALL?

A

blast cells

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15
Q

what syndrome is ALL associated with?

A

down syndrome

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16
Q

how does ALL present?

A

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)

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17
Q

mortality in ALL?

A

most cases are cured with chemo +/- stem cell transplant

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18
Q

what is CML?

A

chronic accumulation of myeloid cells in the bone marrow and blood

19
Q

what genetic mutation causes CML?

A

philedelphia chromosome (balanced 9:22 translocation)

20
Q

age of onset of CML?

A

can be any age but generally middle aged

21
Q

3 phases of CML?

A

chronic phase
accelerated phase
blast phase
(most people present in the chronic phase)

22
Q

describe chronic phase of CML?

A

can last around 5 years
often asymptomatic
immunocompetent but have high neutrophils and sometimes basophils (bc they have myeloid lineage)

23
Q

describe accelerated phase of CML?

A

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%)

24
Q

describe blast phase of CML?

A

severe symptoms of pancytopaenia
even higher proportion of bone marrow taken up by blast cells (30%)
often fatal

25
Q

what is AML?

A

acute proliferation of myeloid lineage cells

different types of AML exist with cytogenic differences and differences in presentation

26
Q

most common leukaemia in middle age?

A

AML

27
Q

AML can be the result of transformation from what other conditions?

A

myeloproliferative disorders such as polycythaemia vera or myelofibrosis

28
Q

risk factors for AML?

A

previous radiotherapy
exposure to benzene
down syndrome??

29
Q

how does AML present?

A 
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
30
Q

features of AML on bone marrow biopsy?

A

at least 30% occupied by blast cells

31
Q

AML blood film?

A 
auer rods (within cytoplasm of blast cells)
high proportion of blast cells (>30%)
32
Q

how is AML managed?

A

chemo

bone marrow transplant depending on type of disease present

33
Q

most common leukaemia in children (buzzwordy)?

A

ALL

34
Q

leukaemia associated with down syndrome (buzzword)?

A

ALL

35
Q

most common leukaemia in adults overall (buzzwordy)?

A

CLL

36
Q

which leukaemia has 3 phases?

A

CML

37
Q

which leukaemia can be result of transformation from myeloproliferative disorder?

A

AML

38
Q

which leukaemia is associated with warm autoimmune haemolytic anaemia?

A

CLL

39
Q

which leukaemia is associated with auer rods?

A

AML

40
Q

which leukaemia is associated with richters transformation into high grade lymphoma?

A

CLL

41
Q

which leukaemia is associated with smudge cells?

A

CLL

42
Q

which leukaemia is associated with philadelphia chromosome?

A

CML

43
Q

most common acute leukaemia in adults?

A

AML

Year 4 (83 decks)

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