LEUKAEMIA

Question 1

Two main divisions of leukemia are

Answer 1

Lymphoid leukemia
Myeloid leukemia

Question 2

The four types of leukemia

Answer 2

Acute lymphoblastic leukaemia (ALL)
Chronic lymphoblastic leukaemia (CLL) Acute myeloid leukaemia (AML)
Chronic myeloid leukaemia (CML)

Question 3

Commonest leukemia in children and adults

Answer 3

Children- ALL
Adults- CLL
AML and CML cut across all ages

Question 3

Factors associated with leukemia include

Answer 3

Viruses e.g. human T lymphotrophic virus type 1 (HTLV-1) and epstein barr virus (EBV)
Chemicals e.g. benzene, industrial solvents, pesticides (Lindane), dyes,
Drugs e.g. alkylating agents such as melphalan
Ionizing radiation

Question 4

Symptoms of chronic leukemia

Answer 4

Asymptomatic
Dragging sensation (left side of abdomen)
Easy satiety
Lymph node swelling
Weight loss
Generalized itch
Excessive sweating
Priapism
Hearing loss

Question 4

Symptoms of acute leukemia include

Answer 4

Fever
Lymph node swelling
Easy fatiguability
Bruising tendencies
Bone and joint pain (especially in children

Question 4

Signs of chronic leukemia

Answer 4

Splenomegaly
Weight loss
Pallor
Generalized lymph node enlargement in CLL

Question 5

Signs of acute leukemia

Answer 5

Pallor
Fever
Skin and mucosal haemorrhages
Gum hypertrophy (AML subtype 5)
Firm, rubbery, non-tender lymph nodes (lymphoid leukaemia)
Splenomegaly

Question 5

Investigations in leukemia

Answer 5

FBC and blood film comment
Bone marrow aspirate
Uric acid levels
LDH
BUE and creatinine
Liver function tests
Septic screen (especially in acute leukaemia)
LP for CSF cytology (especially in acute lymphoid leukaemia)

Question 6

Non-pharmacological interventions in leukemia

Answer 6

Ensure good hydration
Ensure good nutrition and food hygiene
Ensure good oral and personal hygiene

Question 7

Treatment objectives in leukemia

Answer 7

To aim for a cure in ALL in both children and adults
To achieve remission and prolong good quality life in AML
To aim for a complete haematological remission or cure in philadelphia positive CML
To control white cell counts, symptoms and prolong good quality of life in philadelphia negative CML
To provide supportive treatment (pain relief, transfusion support, treat infections, counselling)

Question 8

Supportive treatment for newly diagnosed leukemia

Answer 8

Pain relief (avoid NSAIDS)
Packed red cells transfusion and platelet transfusion when indicated
IV and oral fluids
Allopurinol to mitigate tumour lysis
Treatment of infections