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Clinical haematology > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

What is leukaemia

A

blood cancers that being with mutation of a bone marrow progenitor cell–

abnormal cells in blood

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2
Q

What are the types of leukaemia

A

Acute myeloid leukemia
Acute lymphoblastic leukaemia
Chronic lymphocytic leukaemia
chronic myeloid leukaemia

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3
Q

What is the difference between acute and chronic leukaemia

A

acute - result of impaired cell differentiation hence large numbers of malignant precursor cells in bone marrow

chronic - result of excessive proliferation of mature malignant cells - cell differentiation is unaffected

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4
Q

What is the difference between myeloid and lymphocytic leukaemia

A

myeloid leukaemia - results from a myeloid precursor cell ( neutrophils)

lymphocytic leukaemia arise from lymphoid precursor - B cells

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5
Q

What is AML

A

most common in adults
median age of onset -65

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6
Q

What are some risk factors of AML

A

trisomy 21
irradiation

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7
Q

How may someone with AML present

A

fever
bone marrow failure
- neutropenia- infections
-anaemia - pallor
-thrombocytopenia - bleeding

Tissue infiltration
- swollen gums
-hepatomegaly and splenomegaly

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8
Q

How is AML classified

A

subdivided based on potential aetiology

  • AML with recurrent genetic abnormalities

-AML with myelodysplasia related changes

-therapy related AML - associated with previous chemo

-AML not otherwise specified

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9
Q

What investigations are required for AML

A

FBC
- high WCC , panctypoenia

bone marrow biopsy
- Auer rod cells ( needle shaped )
>20% blast cells

  • carry out cytogenic analysis
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10
Q

What is management of AML

A

chemotherapy
-CYTARABINE( anti-metabolic agent)

supportive
- blood products
-infection prophylaxis
-allopurinol, fluids, electrolytes – ( prevent tumour lysis syndrome)
- bone marrow transplant

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11
Q

What is the prognosis of AML

A

death occurs within 2 months with no treatment

20% 3 year survical in those who undergo treatment

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12
Q

What is ALL

A

most common cancer in children

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13
Q

What are risk factors of ALL

A

trisomy 21
neurofibromatosis

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14
Q

How may someone with ALL present

A

FLAWS
Bone marrow failure
- neutropenia - infections
-anaemia - pallor
-thrombocytopenia - bleeding

Tissue infiltration
-lymphadenopathy
-hepatosplenomegaly
-tender bones
-painless unilateral testicular swelling

meningeal involvement -headache, neck stiffness, cranial nerve palsies

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15
Q

What investigations are required for ALL

A

FBC -
high WCC ( blast cells) , pancytopenia

Bone marrow biopsy
>20% lymphoblasts

immunophenotyping

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16
Q

What is the management of ALL

A

chemotherapy
supportive
-blood products
-infection prophylaxis
- allopurinol, fluids, electrolytes

  • allo-stem cell transplant
17
Q

What is prognosis of ALL

A

children have cure rate of 70-90%

18
Q

What is CML

A

most common in middle aged males

associated with philadelphia chromosome

19
Q

What is the main risk factor for CML

A

radiation exposure

20
Q

How does CML usually develop and progress

A

Chronic phase - 3-5 years

accelerated phase - months

blastic phase - acute leukaemia transformation

21
Q

How may someone with CML present

A

can be asymptomatic
insidious onset

MASSIVE SPLENOMEGALY

FLAWS

Bone marrow failure
- neutropenia - infections
-anaemia -pallor
-thrombocytopenia - bleeding

Hyperviscosity
- neurological deficits, visual changes and mucosal bleeding

22
Q

What are investigations for CML

A

FBC
-pancytopenia , elevated WCC, raised BASOPHILS

Bone marrow aspirate -
increased myeloblasts
hypercellular

PCR for BCR-ABL1 fusion gene

23
Q

How do you manage CML

A

Tyrosine kinase inhibitors
IMATINIB

24
Q

What is prognosis for CML

A

median survival is 5-6 years

25
Q

What is CLL

A

most common in patients over 60

failure of apoptosis - increased number of non-functional lymphocytes

26
Q

How does CLL present

A

usually asymptomatic
insidious onset

during later stages of disease

-symmetrical non tender lymphadenopathy

  • bone marrow failure
    neutropenia - infections
    anaemia - pallor- AIHA
    thrombocytopenia - bleeding

FLAWS

27
Q

What staging is used for CLL

A

Binet classification in europe
Rai classification in USA

28
Q

What investigations are required for CLL

A

FBC
high WCC >100, normal Hb and platelets

Low serum immunoglobulin

Blood film -
smudge/smear cells

lymph node biopsy and phenotyping

Diagnosis is usually made on incidental routine bloods

29
Q

How do you manage CLL

A

watchful waiting if slowly progressive

supportive treatment

RITUXIMAB

30
Q

What is prognosis for CLL

A

1/3 cases don’t progress

1/3 progress slowly

1/3 progress actively

Clinical haematology (5 decks)

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