Leukaemia Flashcards
What is leukaemia?
Cancer of stem cells in bone marrow
Types of leukaemia
Acute lymphoblastuc leukaemia
Acute myeloid leukaemia
Chronic myeloid leukaemia
When does ALL peak?
Most common leukaemia
Peaks in childre 2-3 years
When does AML peak?
Under 2 years
Second most common leukaemia
What happens in leukaemia?
Genetic mutation in precursor cell-> excessive production of one type abnormal white blood cell -> supression of other cell lines -> pancytopenia
What is pancytopenia?
Low:
RBC - anaemia
WBC - leukopenia
Platelets - thrombocytopenia
One proliferative line
What conidtions increase risk of developing leukaemia?
Radiation exposure during pregnancy
Downs syndrome
Kleinfelter syndrome
Noonan syndrome
Fanconis anaemia
What is kleinfelter syndrome
What is noonan syndrome
What is fanconis anaemia
Presentation of leukaemia
Typically non speicifc
Persistent fatigue
unexplained fever
FTT
Weight loss
Nigth sweats
Pallor (anaemia)
Petechiae + abnormal bruising
Abdo pain
Genrealised lymphadenopathy
Unexplained or persistent bone or joint pain
Hepatosplenomagealy
What children do NICE recommend referring for leukaemia assessmetn?
Unexplained peteciae or hepatomegaly
What need to do NICE if leukaemia suspected?
FBC in 48 hours
Investigations to establish leukaemia diagnosis
FBC - anaemia, leukopenia, thrombocytopenia, high WCC abnormal count
Blood ilm - blast cells
Bone marrow biopsy
Lymph node biopsy
What further investigtaions done to stage leukaemia?
CXR
CT scan
Lumbar puncture
Genetic analysis and immunophenotyping of abnoraml cells
Treatment for leukaemia?
Paediatrci oncology MDT
Chemotherapy primary treatment
Radiotherapy
Bone marrow transpplant
Surgery
Complucations of chemotherapy
Failure to treat leukaemia
Stunted growth and development
Immunodeficiency and infections
Neurotoxicity
Infertility
Secondary malignancy
Cardiotoxicitit
Prognosis leukaemia
ALL - 80%, individual
AMl
On exam leukaemia
Weigth loss
Pallor
Petechial rash , bruise
Tachy
Flow murmur
Hepatosplenomaegaly
Lymphadenopathy
Red flags leukaemia
Unexplained petechiae/hepatosplenomegaly
Pallor
Geeky medics
What is the result of a blood film in leukaemia
Immature blast cells on blood film - abnormal
Why do CXR in leukaemia
Check for mediastinal mass
What is tumour lysis syndrome?
Oncological emergency from lysis of tumour cells
-> hyperphosphatemia/kalemia/calcemia/uricaemia
Presentation tumour lysis syndrome
AKI, cardiac, arrhythmias, seizures, N+V
Treat tumour lysis syndomre
Allopurinol/Rasburicase - break down uric acid
Chemotherapy in children
Stunted growth
Infertility
Cardiac/other orgna damage
Side effects
Children often recover well
