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Haematology > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

What is leukaemia?

A

cancer of a particular line of stem cells in the bone marrow, causing unregulated production of a specific type of blood cell.

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2
Q

What are the 4 types of leukaemia?

A
  1. Acute myeloid leukaemia (rapidly progressing cancer of the myeloid cell line)
    1. Acute lymphoblastic leukaemia (rapidly progressing cancer of the lymphoid cell line)
    2. Chronic myeloid leukaemia (slowly progressing cancer of the myeloid cell line)
    3. Chronic lymphocytic leukaemia (slowly progressing cancer of the lymphoid cell line)
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3
Q

Which leukaemia is most common in children?

A

ALL

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4
Q

Which leukaemia is associated with auer rods?

A

AML

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5
Q

Which leukaemia can be as a result of myeloproliferative disorder?

A

AML

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6
Q

Which leukaemia is associated with Down syndrome?

A

ALL

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7
Q

Which leukaemia has 3 phases?

A

CML

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8
Q

Which leukaemia is associated with the Philadelphia chromosome?

A

CML

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9
Q

Which leukaemia is associated with warm haemolytic anaemia, ritchers transformation and smudge cells?

A

CLL

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10
Q

What is pancytopenia?

A

combination of low red blood cells (anaemia), white blood cells (leukopenia) and platelets (thrombocytopenia).

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11
Q

What are some potential presenting features of leukaemia? (8)

A

• Fatigue
• Fever
• Pallor due to anaemia
• Petechiae or bruising due to thrombocytopenia
• Abnormal bleeding
• Lymphadenopathy
• Hepatosplenomegaly
• Failure to thrive (children)

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12
Q

What is one of the key features of leukaemia?

A

bleeding under the skin due to thrombocytopenia.

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13
Q

What are petechiae?

A

Non blanching lesions <3mm caused by burst capillary’s

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14
Q

What are purpura?

A

Non-blanching lesions from 3-10mm

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15
Q

What is ecchymosis?

A

Non blanching lesion >1cm

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16
Q

What is seen on a blood film in AML? (2)

A

High proportion of Blast cells
Auer rods in cytoplasm of blast cells

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17
Q

What is seen on bone marrow biopsy in AML?

A

High proportion of blast cells

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18
Q

What is the most commonly proliferated cell in ALL?

A

B lymphocytes

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19
Q

What feature is present in ALL but more commonly seen in CML?

A

Philadelphia chromosome

20
Q

What are the 3 phases of CML?

A
  1. Chronic phase
    1. Accelerated phase
    2. Blast phase
21
Q

What is the longest phase of CML?

A

Chronic phase - can last several years

22
Q

When does the accelerated phase of CML occur?

A

• Occurs when the abnormal blast cells take up a high proportion (10-20%) of the bone marrow and blood cells.

23
Q

What symptoms are acquired in the accelerated phase of CML? (3)

A

Anaemia
Thrombocytopenia
Immunodeficiency

24
Q

What is the symptoms in the blast phase of CML?

A

• The blast phase has severe symptoms and pancytopenia and is often fatal.

25
Q

When is the blast phase in CML?

A

• Follows the accelerated phase and involves an even higher proportion (over 20%) of blast cells in the blood.

26
Q

Which leukaemia is the Philadelphia chromosome most associated with?

A

CML

27
Q

What is the Philadelphia chromosome?

A

○ This refers to an abnormal chromosome 22 caused by a reciprocal translocation (swap) of genetic material between a section of chromosome 9 and chromosome 22.
○ This translocation creates an abnormal gene sequence called BCR-ABL1, which codes for an abnormal tyrosine kinase enzyme that drives the proliferation of the abnormal cells.

28
Q

What does BCR-ABL1 code for?

A

An abnormal tyrosine kinase enzyme that drives the drives proliferation of abnormal cells

29
Q

Which cell is most often proliferated in CLL?

A

B lymphocytes

30
Q

What is the presentation of CLL?

A

• It is often asymptomatic but can present with infections, anaemia, bleeding and weight loss.

31
Q

What is anaemia is CLL associated with?

A

Warm autoimmune haemolytic anaemia

32
Q

What is ritchers transformation?

A

Rare transformation of CLL into high grade b cell lymphoma

33
Q

What’s seen on a blood film in CLL?

A

Smear or smudge cells

34
Q

What investigation is done in suspected leukaemia? When?

A

Fbc within 48hours

35
Q

When should children be sent for immediate specialist assessment in suspected leukaemia?

A

Petechiae or hepatosplenomegaly

36
Q

What test is a sign for non-specific marker of tissue damage in leukaemia?

A

Lactate dehydrogenase (LDH)

37
Q

What test gives a definitive diagnosis of leukaemia?

A

Bone marrow biopsy

38
Q

Where are bone marrow biopsies usually taken from?

A

Iliac crest

39
Q

What are the 2 types of bone marrow biopsy?

A

○ Bone marrow aspiration involves taking a liquid sample of cells from within the bone marrow.
○ Bone marrow trephine involves taking a solid core sample of the bone marrow and provides a better assessment of the cells and structure.

40
Q

What is leukaemia mainly treated with?

A

Chemo and targeted therapies

41
Q

What are 2 targeted therapies used in CLL?

A

• Tyrosine kinase inhibitors (e.g., ibrutinib)
Monoclonal antibodies (e.g., rituximab, which targets B-cells)

42
Q

What are some complications of chemo? (8)

A

• Failure to treat cancer
• Stunted growth and development in children
• Infections due to immunosuppression
• Neurotoxicity
• Infertility
• Secondary malignancy
• Cardiotoxicity (heart damage)
• Tumour lysis syndrome

43
Q

What is tumour lysis syndrome?

A

Tumour lysis syndrome results from chemicals released when cells are destroyed by chemotherapy,

44
Q

What can tumour lysis syndrome result in? (4)

A

High Uric acid
High potassium
High phosphate
Low calcium

45
Q

What helps prevent tumour lysis syndrome?

A

Good hydration and urine output before chemo

46
Q

What drugs can be used to suppress uric acid levels? (2)

A

Allopurinol
Rasburicase

Haematology (18 decks)

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