Leukaemia Flashcards
What is leukaemia?
cancer of stem cells in bone marrow causing unregulated production of a specific type of blood cell (often white blood cells)
What is pancytopenia?
1) anaemia
2) leukopenia
3) thrombocytopenia
What causes pancytopenia in leukaemia?
the excessive production of a single type of cell can suppress the other lines, causing underproduction of other cell types
What is acute lymphoblastic leukaemia?
cancer affecting one of the lymphocyte precursor cells causing an acute proliferation of a single type of lymphocyte (usually B cells)
In what patient age group is acute lymphoblastic leukaemia most commonly seen in?
children under 5
What chromosomal disease is acute lymphoblastic leukaemia associated with?
Down’s syndrome
What is chronic lymphoblastic leukaemia?
slow proliferation of a single type of well-differentiated lymphocyte, usually B cells
In what patient age group is chronic lymphoblastic leukaemia most commonly seen in?
adults over 60
True or false: chronic lymphoblastic leukaemia is often asymptomatic
True
What is a classic haemolytic feature of chronic lymphoblastic leukaemia?
warm autoimmune haemolytic anaemia
What is warm autoimmune haemolytic anaemia?
where autoantibodies react with red blood cells at temperatures over 37 degrees C
What is the name given to the rare transformation of chronic lymphoblastic leukaemia into a high grade B cell lymphoma?
Richter’s transformation
What blood film sign is associated with chronic lymphoblastic leukaemia?
smear/ smudge cells
What are smear/smudge cells?
ruptured WBCs
In what age group is acute myeloid leukaemia seen in?
middle age onwards
Give two myeloproliferative diseases that may progress to acute myeloid leukaemia?
1) polycythaemia ruby vera
2) myelofibrosis
Give 2 blood film findings assocaited with acute myeloid leukaemia:
1) high proportion of blast cells
2) auer rods in blast cell cytoplasms
What are auer rods?
crystalline cytoplasmic inclusion bodies
What chromosomal disease is associated with chronic myeloid leukaemia?
Philadelphia chromosome
What are the 3 phases of chronic myeloid leukaemia?
1) chronic phase
2) accelerated phase
3) blast phase
Describe the chronic phase of chronic myeloid leukaemia:
often asymptomatic with raised WCC (often incidental finding) which can last several years
Describe the accelerated phase of chronic myeloid leukaemia:
where abnormal blast cells take of 10-20% of bone marrow and blood content, allowing symptoms such as anaemia, thrombocytopenia and immunodeficiency to develop
Describe the blast phase of chronic myeloid leukaemia:
where an even higher proportion of blast cells (over 20%) is seen in the blood, causing severe and even fatal symptoms
Give 8 clinical presentations associated with leukaemia:
1) fatigue
2) fever
3) pallor
4) petechiae/ bruising
5) abnormal bleeding
6) lymphadenopathy
7) hepatosplenomegaly
8) failure to thrive
Give the size threshold for petechiae:
less than 3mm
Give the size range for purpura:
3-10mm
Give the size threshold for ecchymosis:
> 1cm
What initial investigation should be used within 48hrs of suspected leukaemia?
full blood count
Give 7 investigations for leukaemia:
1) FBC
2) blood film
3) lactate dehydrogenase
4) bone marrow biopsy
5) CT and PET scans
6) lymph node biopsy
7) genetic testing and immunotyping
What is the gold standard diagnostic test for leukaemia?
bone marrow biopsy
Where are bone marrow biopsies usually taken from?
iliac crest
What are the two types of bone marrow biopsies?
1) aspiration (liquid sample of cells)
2) trephine (solid core sample of bone marrow)
Which provides a better assessment of cells, aspiration or trephine bone marrow biopsies?
trephine
Give 3 general management strategies used for leukaemia:
1) chemotherapy
2) targeted therapy
3) bone marrow transplants
Give 2 targeted therapies for leukaemia:
1) ibrutinib (tyrosine kinase inhibitor)
2) rituximab (monoclonal antibody against B cells)
What complication is associated with chemotherapy rapidly destroying tumour cells?
tumour lysis syndrome
Give 4 U+E imbalances seen in tumour lysis syndrome:
1) increased uric acid
2) hyperkalaemia
3) hyperphosphatemia
4) hypocalcaemia
Name 2 drugs that can be used to supress uric acid levels in tumour lysis syndrome?
1) allopurinol
2) rasburicase
What complication is associated with raised uric acid in tumour lysis syndrome?
AKI (crystal deposits in kidneys)
Describe how the Philadelphia chromosome can cause chronic myeloid leukaemia:
the reciprocal translocation between chromosomes 9 and 22 results in the abnormal BCR-ABL1 gene sequence which codes for an abnormal tyrosine kinase enzyme which drives the proliferation of abnormal cells
