Leukaemia Flashcards
What is leukaemia?
Uncontrolled proliferation of immature WBCs that then accumulate in the blood or bone marrow.
What are the different types of leukaemia you can have?
- Acute Lymphoblastic Leukaemia (ALL)
- Acute Myeloid Leukaemia (AML)
- Chronic Lymphocytic Leukaemia (CLL)
- Chronic Myeloid Leukaemia (CML)
What is Acute Lymphoblastic Leukaemia (ALL) ?
- Most common malignant disease in children, peak incidence 2-5 years old
- No identified cause or risk factors in most cases, however Down Syndrome increases risk
What is Acute Myeloid Leukaemia (AML)?
- More common in adults, peak incidence 65 years old
- Pre-existing haematopoietic disorder is most common cause → aplastic anaemia, myeloproliferative disorders (eg. polycythaemia vera).
*1/3 of Myelodysplasia progresses to AML - Also associated with Down Syndrome
- Auer Rods on cytology → large pink/red stained needle-like structures
What is Chronic Lymphocytic Leukaemia (CLL)?
- Low-grade B-cell lymphoma caused by a monoclonal proliferation of well-differentiated lymphocytes which are almost always B-cells (99%)
- M>F, median age at diagnosis is 70-72 years old (most common type of leukaemia in adults)
- Richter Transformation into non-Hodgkin’s lymphoma (presents with lymph node swelling, fever, weight loss, night sweats)
- Smudge Cells → remnants of cells that have no identifiable plasma membrane or nuclear structure
What is Chronic Myeloid Leukaemia (CML)?
- Overexpression of cells of myeloid lineage, especially granulocytes
- Peak incidence at 50-60 years old
- Philadelphia Chromosome → reciprocal translocation between chromosome 9 and 22. The resulting BCR-ABL gene codes for a fusion protein that has tyrosine kinase activity in excess of normal.
What are the presenting symptoms of acute leukaemia?
- Sudden onset of symptoms
- Anaemia → fatigue, pallor, weakness
- Thrombocytopenia → epistaxis, bleeding gums, petechiae, purpura, easy bruising
- Frequent Infections → due to immature leukocytes and leukopenia
- Hepatosplenomegaly
- ALL ⇒ Lymphadenopathy and Fevers (Not AML) ⇒ DISTINGUISHING
What are the presenting symptoms of chronic lymphocytic leukaemia?
Many cases remain asymptomatic for long period, leading to late diagnosis. B symptoms (weight loss, fever, night sweats), painless lymphadenopathy (more marked than CML), recurrent infections (due to hypogammaglobulinaemia), symptoms of anaemia (warm AIHA, IgG) and thrombocytopenia, pruritus.
What are the presenting symptoms of chronic myeloid leukaemia?
Weight loss, fever, night sweats, massive splenomegaly, anaemia, Hyperviscosity symptoms (increased thrombotic risk)
What investigations are used to diagnose/ monitor acute leukaemia?
- FBC (ALL + AML) → neutropenia, thrombocytopenia, anaemia
- Peripheral Blood Smear → presence of blast cells (immature WBCs)
- Bone Marrow Aspiration & Biopsy → confirm diagnosis. Hypercellular marrow with >20% of cells being lymphoblasts (ALL).
What investigations are used to diagnose/ monitor chronic lymphocytic leukaemia?
FBC shows persistent lymphocytosis with high percentage of small sized, mature lymphocytes. Blood Smear shows smudge cells.
What investigations are used to diagnose/ monitor chronic myeloid leukaemia?
- FBC shows leukocytosis, thrombocytosis, basophilia and eosinophilia. Decreased leukocyte alkaline phosphatase (LAP). Cytogenic testing for confirmation of Philadelphia chromosome.
- 0-24 yrs old ⇒ refer for immediate specialist assessment for leukaemia if unexplained petechiae or hepatosplenomegaly (urgent FBC)
How is leukaemia managed?
- Chemotherapy +/- Radiotherapy
- Stem Cell Transplantation
- Chronic Myeloid Leukaemia → 1st line is Tyrosine Kinase inhibitors (Imatinib)
What complications may arise following leukaemia?
- Treatment with chemotherapy leads to Tumour Lysis Syndrome (hyperkalaemia, hyperuricaemia, hyperphosphatemia, and hypocalcaemia - allopurinol can be used for prophylaxis of TLS).
Tumour Lysis syndrome = PUKE Calcium:
- Phosphorus
- Uric acid
- Potassium (K) Elevated
- Calcium reduced
