Leukaemia

Question 1

What are the features of acute lymphoblastic leukaemia?

Answer 1

Common in children

Proliferation of lymphoid precursors

Question 2

What are the three pathologies that cause symptoms in ALL?

Answer 2

Infiltration symptoms
Marrow symptoms
CNS involvement

Question 3

What are marrow symptoms in ALL?

Answer 3

Anaemia - pallor
Infection
Bleeding - petichiae
Joint pain

Question 4

What investigations will show marrow pathology?

Answer 4

FBC
Blood film
Bone marrow biopsy
High blast cells but can also be low

Question 5

What are infltration symptoms in ALL?

Answer 5

LUQ fullness

SVC obstruction

Question 6

What are the CNS symptoms in ALL?

Answer 6

Headache
Altered mental status
Irritability
Cranial nerve palsy (III, IV, VI, VIII)

Question 7

How do you investigate inflitration?

Answer 7

CXR
CT Scan
Lymphadenopathy, Spleno/Hepato/Orchidomegaly

Question 8

What is the management of ALL?

Answer 8

Educate and motivate
Supportive e.g. fluids for viscous blood
Allopurinol for high urate
Be cautious with infections
Chemotherapy

Question 9

What comprises chemotherapy in ALL?

Answer 9

Induction
Consolidation
Maintenance

Consider bone marrow transplant once remission is induced

Question 10

What are the features of acute myeloid leukaemia?

Answer 10

Adults av age 67
Myeloid cells arrested in early stage
Failure of apoptosis –> accumulate in liver and spleen

Question 11

What categories of symptoms are seen in AML?

Answer 11

Marrow symptoms
Infiltration symptoms
Leukostasis

Question 12

What is a difference in presentation of ALL and AML?

Answer 12

Age
No lymph node involvement in AML
Gum hypertrophy more common in AML
CNS involvement in ALL 
Three phase treatment for ALL 
Two phase treatment for AML

Question 13

What is investigation for AML?

Answer 13

Blast cells > 20% on bone marrow aspirate

Question 14

What are presentations of leukostasis?

Answer 14

Confusion
Hypoxia
Retinal haemorrhage

Question 15

What is the management for AML?

Answer 15

5 cycles of chemotherapy (Induction and consolidation)

Bone marrow transplant

Question 16

What are the features of Chronic myeloid leukaemia?

Answer 16

Uncontrolled clonal proliferation of myeloid cells

40-60yrs

Question 17

What are the presenting features of CML?

Answer 17

Weight loss
Tiredness
Fever, Sweats
Gout (purine breakdown)
Bleeding (platelet dysfunction)
Abdo discomfort (splenic enlargement)

Question 18

What are investigations for CML?

Answer 18

High WBC
Hb low or normal
High Urate

Question 19

What are the three phases of CML?

Answer 19

Chronic
Accelerated phase
Blast transformation

Question 20

What is the management for CML?

Answer 20

Imatinib - an inhibitor of tyrosine kinase

AML treatment if in final phase

Question 21

What are the features of chronic lymphocytic leukaemia?

Answer 21

Increase lymphocytes
Most common leukaemia
Most common in males
70-80% of pts asympto

Question 22

What are the presenting features of CLL?

Answer 22

Advanced disease:
Lymphadenopathy - painless, symmetrical
Spleno/Hepatomegaly
Recurrent infections
Autoimmune symptoms e.g. haemolytic anaemia

Question 23

What is the management for CLL?

Answer 23

Only treat if symptomatic

Question 24

What are some differences between CML and CLL?

Answer 24

CML massive splenomegaly
CLL auto-immune disorders
B-symptoms in both but CLL can be asymptomatic 
Recurrent infections in CLL
Treatment is different 
Cause is different