Leukaemia Flashcards
What ages do different leukaemias present?
ALL: <5, >45
CLL: >55
CML: >65
ALL: >75
ALL pathophysiology
Acute proliferation of a single type of lymphocyte (usually B)
CML pathophysiology
Chronic proliferation of a single type of lymphocyte, usually B
CML pathophysiology
Chronic phase: 5 years, asymptomatic, incidental diagnosis from raised WCC
Acute phase: abnormal blast cells take up 10-20% of BM and blood. Becomes symptomatic - anaemia, thrombocytopenia, immunosuppressant
Blast phase: >30% abnormal blast cells, severe symptoms and pancytopenia, often fatal
What is associated with ALL
T21
Philadelphia chromosome
What is associated with CLL
Associated with warm haemolytic anaemia
Richter’s transformation - into high-grade lymphoma
What is associated with CML
Philadelphia chromosome
What is associated with AML
Transformation from a myeloproliferative disorder
What would you find on a blood film in ALL?
Blast cells
What would CLL look like on a blood film
Smear / smudge cells
What would AML look like on blood film
Blast cells
What would CML look like on blood film
Blast cells with Auer rods
Presentation of leukaemia
Non-specific
Fatigue
Fever, failure to thrive, pallor due to anaemia, petechiae, abnormal bruising, bleeding, lymphadenopathy, hepatosplenomegaly
Ix leukaemia
FBC <48hrs LDH Blood film BM biopsy LN biopsy CXR LP CT / MRI / PET
Management of leukaemia
Chemotherapy and steroids
Radiotherapy, SC transplant, surgery
Complications of chemotherapy in leukaemia
Failure, stunted growth and development in children, neurotoxicity, infertility, 2o malignancy, cardiotoxicity, tumour lysis syndrome
BM biopsy (3)
aspiration: involves a liquid sample of cells from BM
trephine: solid core sample of BM, provides a better assessment of cells and structure but takes a few days to prepare
biopsy: taken from iliac crest under LA, samples can be examined straight away.
