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Haematology > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

Clinical Features of Acute Leukaemia?

A

BM Function Failure - Anaemia, Thrombocytopenia, Neutropenia

Organ Infiltration - Hepatomegaly, splenomegaly, lymphadenopathy, bone pain, CNS, skin, gun hypertrophy

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2
Q

Causes of Acute Leukaemia

A

Unknown
Ionising radiation
Cytotoxic drugs
Benzene
Pre-leukaemic disorders - Myelodysplastic/proliferative
Down’s Syndrome
Neonates (30% develop transient myelopoiesis which resolves itself)

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3
Q

Diagnosis of Acute Leukaemia

A

Morphology + cytochemisty (stains)
Immunophenotyping (lineage, differentiation)
Cytogenetics (chromosomal translocations)
Molecular genetics (PCR, point mutations)

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4
Q

ALL affects which age group?

A

Children

Children get it ALL

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5
Q

AML affects which age group

A

Adulthood (increases with age)

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6
Q

Additional features of ALL

A

Lymphadenopathy
CNS involvement
Testicular enlargement
Thymic enlargement

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7
Q

Additional features of AML

A

Lymphadenopathy less common
M3 - Acute promyelocytic leukaemia - prone to DIC
M4+5: Monoblasts/monocytes - skin / gum infiltration + hypokalaemia

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8
Q

Diagnosis of ALL

A

High WCC

Lymphocytes or precursors

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9
Q

Diagnosis of AML

A

High WCC
Auer rods and granules
Myeloperoxidase and Sudan Black B stains

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10
Q

Treatment for ALL

A

Remission induction: Chemo with steroids
Consolidation: High dose multi chemo, CNS treatment
Maintenance: 2 years in girls and adults, 3 years in boys
Consider allo-Stem Cell tranplant
Supportive: BLood products, Abx, Allopurinol, fluid, electrolytes - prevent tumour lysis syndrome

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11
Q

Treatment for AML

A 
Similar principles
No CNS prophylaxis / maintenance therapy
Consider Allo-SCT in young
ATRA for M3
Supportive
Prognosis worse with age
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12
Q

A myeloproliferative disease affecting middle-aged (40 to 60)

A

CML
Diagnosed on routine bloods
Massive splenomegaly

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13
Q

Investigations for CML

A 
Ph+ve (Philadelphia chromosome) in 80%
Chromosomal translocation (9;22)
PCR for BRC-ABL
Monitor disease and therapeutic response
WBC, Neutrophils 50-500
Hypercellular BM with spectrum of immature and mature granulocytes in blood
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14
Q

Definintion and treatment of Chronic phase of CML

A

Blast phase

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15
Q

Definition of Accelerated phase of CML

A

> 10% Blasts in blood
Lasting up to one year
Increasing manifestations
Less responsive

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16
Q

Definition of Blast phase of CML

A

> 20% Blasts in blood
Months of weight loss, lethargy, night sweats
Resembles Acute leukaemia
Treatment is similar to AML with possible SCT for young

17
Q

A lymphoproliferative disease with the same process as SLL but presents in the BM of the elderly mainly in men

A

CLL

18
Q

Clinical features of CLL

A

Asymptomatic diagnosed on blood (80%)
Symmetrical painless lymphadenopathy
BM failure
Weight loss, low fever, night sweats
Hepatosplenomegaly (less prominent)
Assoc with autoimmunity (Evan’s syndrome) AIHA, ITP
Can progress to lymphoma (DLBC) - Richter’s transformation

19
Q

Investigations of CLL

A

High WBC with lymphocytosis >5 (high % composed of small mature lymphocytes)
Low serum Ig
Smear CLLs seen on blood film
Abnormal BM - lymphocytic replacement

20
Q

In CLL, if LDH is raised what is the prognosis?

A

Bad

21
Q

In CLL, if CD38 is positive what is the prognosis

A

bad

22
Q

In CLL, if there has been an 11q23 deletion what is the prognosis

A

Bad

23
Q

In CLL if there is a hypermutated Ig gene what is the prognosis

A

Good

24
Q

In CLL if there is a low ZAP-70 expresssion what is the prognosis

A

good

25
Q

In CLL, if there has been a 13q14 deletion what is the prognosis

A

Good

26
Q

What is Binet staging

A 
Staging for CLL
Stage A
High WBC
3 groups of enlarged LNs
Stage C
Anaemia of Thrombocytopenia
27
Q

Treatment for CLL

A 
1st Line Clorambucil (chemo)
Fludarabine (purine analogue)
Alemtuzumab (anti-CD52)
Steroids
SCT in young and fit

Haematology (17 decks)

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