Leukaemia Flashcards
What are the four types of leukaemia?
Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)
Chronic myeloid leukaemia (CML)
Chronic lymphocytic leukaemia (CLL)
How quickly growing are the 4 types?
- Acute = rapid growing
- Chronic = slow growing
What is the common presenting age for leukaemia?
60-70 except
ALL = children <5 yrs
What is the pathophysiology for leukaemia?
Genetic mutation of one precursor in bone marrow
Excessive production of single WBC
Can result in pancytopenia
Presentation for leukaemia?
- non-specific:
- Fatigue
- Fever
- Pallor due to anaemia
- Petechiae or bruising due to thrombocytopenia
- non-blanching regions; <3cm caused by burst capillaries
- Abnormal bleeding
- Lymphadenopathy
- Hepatosplenomegaly
- Failure to thrive (children)
Investigations for leukaemia?
FBC
Blood film
LDH
Bone marrow biopsy
Lymph node biopsies
Immunophenotying
Describe acute lymphoblastic leukaemia ( ALL)?
- acute excessive B-lymphocyte accumulation
- affects children <5yrs and older adults
- common with Down’s syndrome
- lymphadenompathy or hepatosplenomegaly
Describe chronic lymphocytic leukaemia (CLL)?
Slow proliferation of B lymphocyte
Incidental finding on lymphocytosis on FBC
Over 60
Asymptomatic
How can CLL present?
Over 60
Can present with infections, anaemia, weight loss, bleeding, lymphadenopathy, splenomegaly
What can CLL develop into?
High grade B cell lymphoma (Ritchter’s transformation)
What kind of anaemia can CLL cause?
Warm haemolytic anaemia
How to diagnose CLL?
Smear/smudge cells on blood film
Immunophenotyping
Treatment for CLL?
Often watch and wait when asymptomatic
Symptomatic - treat with monoclonal antibody’s and chemo (rituximab + fludarabine +cyclophosphamide)
B. Ell signalling inhibitors (iburtinib, venetoclax)
Describe the phases CML?
Three phases (chronic, accelerated, blast)
Chronic = asymptomatic, incidental high WCC
accelerated = symptomatic, anaemia, thrombocytopenia, immunodeficiency
Blast = severe symptoms, pancytopenia, often fatal
Cause of CML?
Philadelphia chromosome (9 and 22 translocation)
Tyrosine kinase enzyme
Symptoms of CML?
Anaemia
Splenomegaly
B symptoms (weight loss, night sweats, early satiety)
How to diagnose CML?
Neutrophilia and granulocyte precursors
Bone marrow (excess myeloid cells)
Treatment for CML?
Tyrosine kinase inhibitor (imatinib)
Describe AML?
Often middle age
Myeloid cell line
Cause of AML?
Arise form myeloproliferative disorders (polycyhemia ruby vera, myelofibrosis , CML, essential thrombocythemia)
V short history
Diagnosis of AML?
Blood film (Auer rods in blast cells)
Blast cells >20%
Immunophenotyping
Treatment for AML?
Chemo (TK inhibitors)
Monoclonal antibodies
Radiotherapy
Bone marrow transplant
Surgery
Complications of AML?
Develop into acute promyelocyctic leukaemia subtype
Associated with DIC
