Leukaemia Flashcards
What is leukaemia?
A cancer of haematopoietic stem cells in the bone marrow, leading to unregulated production of a specific type of blood cell.
What are the broad categories of leukaemia?
- Acute lymphoblastic leukaemia (ALL) * Acute myeloid leukaemia (AML) * Chronic lymphocytic leukaemia (CLL) * Chronic myeloid leukaemia (CML)
In which age group do most types of leukaemia occur?
Patients over 60-70 years.
Which type of leukaemia is most common in children under 5 years?
Acute lymphoblastic leukaemia (ALL).
What are the differentiating characteristics of ALL?
- Children
Down syndrome
What are the differentiating characteristics of AML?
- Prior myeloproliferative disorder *
Auer rods
What are the differentiating characteristics of CLL?
- Warm haemolytic anaemia *
Richter’s transformation *
Smudge cells
What are the differentiating characteristics of CML?
Philadelphia chromosome.
What is the general pathophysiology of leukaemia?
- Genetic mutation in a precursor cell *
Excessive production of a single type of abnormal white blood cell *
Suppression of other cell lines in bone marrow *
Pancytopenia (anaemia, leukopenia, thrombocytopenia)
What are common clinical features of leukaemia?
- Anaemia (fatigue, pallor, dyspnoea on exertion, tachycardia) *
Infections (frequent, severe) *
Bleeding and bruising (petechiae, ecchymoses, epistaxis, gum bleeding, menorrhagia) *
Bone pain *
Lymphadenopathy and hepatosplenomegaly
What is pancytopenia?
- Anaemia (low red blood cells) *
Leukopenia (low white blood cells) *
Thrombocytopenia (low platelets)
Fill in the blank: The top differentials of non-blanching rash include _______.
- Leukaemia * Meningococcal septicaemia * Vasculitis * Henoch-Schonlein purpura * Thrombotic thrombocytopenic purpura * Traumatic or mechanical * Non-accidental injury
What is the suspected cancer pathway for leukaemia diagnosis?
Full blood count within 48hrs and immediate specialist assessment for children with petechiae or hepatosplenomegaly.
What investigations are used for diagnosing leukaemia?
- FBC * Blood film * Lactate dehydrogenase (LDH) * Bone marrow biopsy * CT and PET scans * Lymph node biopsy * Genetic testing
What are the main management strategies for leukaemia?
- Chemotherapy * Targeted therapies (e.g. tyrosine kinase inhibitors, monoclonal antibodies)
What is tumour lysis syndrome?
A complication of treatment resulting from chemicals released when cells are destroyed by chemotherapy, leading to high uric acid, high potassium, high phosphate, and low calcium.
What is the most common childhood malignancy?
Acute lymphoblastic leukaemia (ALL).
What is the pathophysiology of Acute Lymphoblastic Leukaemia?
Acute proliferation of a single lymphocyte type, often B-lymphocytes, leading to excessive accumulation and pancytopenia.
What genetic factors are associated with Acute Lymphoblastic Leukaemia?
- Trisomy 21 (Down syndrome) * Klinefelter’s syndrome * Fanconi anaemia * Viral exposure
What is the most common acute leukaemia in adults?
Acute myeloid leukaemia (AML).
What are the key findings in the blood film for Acute Myeloid Leukaemia?
- High proportion of blast cells * Auer rods in cytoplasm of blast cells
What is the most common leukaemia in adults in western countries?
Chronic lymphocytic leukaemia (CLL).
What are the clinical findings associated with Chronic Lymphocytic Leukaemia?
- Richter’s transformation * Blood film shows smear or smudge cells
What is the Philadelphia chromosome associated with?
Chronic myeloid leukaemia (CML) and it causes an abnormal BCR-ABL1 gene sequence.
What are the three phases of Chronic Myeloid Leukaemia?
- Chronic phase * Accelerated phase * Blast phase
What symptoms are associated with the accelerated phase of Chronic Myeloid Leukaemia?
- Anaemia * Thrombocytopenia * Immunodeficiency
Fill in the blank: In Chronic Myeloid Leukaemia, the blast phase is characterized by more than _______% blast cells in blood.
> 20%
