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 are leukaemias classified?
How rapidly they progress (slow = chronic, fast = acute)
The cell line that is affected (myeloid or lymphoid)
What are the 4 main types of leukaemia?
Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia
Ages affected by leukaemia
Under 5 and over 45 – acute lymphoblastic leukaemia (ALL)
Over 55 – chronic lymphocytic leukaemia (CeLLmates)
Over 65 – chronic myeloid leukaemia (CoMmon)
Over 75 – acute myeloid leukaemia (AMbitions)
Presentation of leukaemia
Fatigue
Fever
Failure to thrive (children)
Pallor due to anaemia
Petechiae and abnormal bruising due to thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
Investigations for leukaemia
Bone marrow biopsy (main investigation for establishing diagnosis)
FBC is initial investigation (within 48hrs for patients with suspected leukaemia)
Blood film to look for abnormal cells and inclusions
LDH (raised)
Chest xray (infection or mediastinal lymphadenopathy)
Lymph node biopsy (to assess lymph node involvement or investigate for lymphoma)
LP (if CNS involvement)
CT, MRI and PET scans for staging and assessing for lymphoma and other tumours
Acute lymphoblastic leukaemia spot diagnosis
Most common leukaemia in children
Associated with Down syndrome
Chronic lymphocytic leukaemia spot diagnosis
Most common leukaemia in adults overall
Associated with warm haemolytic anaemia, Richter’s transformation into lymphoma and smudge/smear cells
Chronic myeloid leukaemia spot diagnosis
Has three phases including a 5 year “asymptomatic chronic phase”
Associated with the Philadelphia chromosome
Acute myeloid leukaemia spot diagnosis
Most common acute adult leukaemia
Can be the result of a transformation from a myeloproliferative disorder
Associated with Auer rods
Management of leukaemia
Oncology MDT
Primarily treated with chemotherapy and steroids
Other therapies include:
Radiotherapy
Bone marrow transplant
Surgery
Complications of chemotherapy
Failure
Stunted growth and development in children
Infections due to immunodeficiency
Neurotoxicity
Infertility
Secondary malignancy
Cardiotoxicity
Tumour lysis syndrome
What is tumour lysis syndrome?
Release of uric acid from cells that are being destroyed by chemotherapy
Uric acid can form crystals in interstitial tissue and tubules of the kidneys and cause AKI
Other chemicals (potassium and phosphate) are also released so need to be monitored and treated appropriately
High phosphate can lead to low calcium, which can have an adverse effect, so calcium is also monitored
