Leukaemia Flashcards
what antigen is expressed by mature red cells
glycophorin A
What enzyme is expressed by mature neutrophils
myeloperoxidase
what investigation do we use to look at antigens expressed on cells
immunophenotyping
what do neutrophils look like under a microscope
segmented nuclei, blue granules
what protein is expressed by all stem cells
CD34
what are the two types of leukaemia
lymphoid
myeloid
normal haemopoiesis is monoclonal/polyclonal
polyclonal
abnormal haemopoiesis is monoclonal/polyclonal
monoclonal
what causes haematological malignancies
genetic mutations (inherited or acquired) driver mutations/background passenger mutations
what developmental stage of haemopoiesis do acute leukaemia’s affect
precursors
what type of cells do chronic leukaemias affect
mature cells
what types of haematological malignancies are more aggressive
acute leukaemias
high grade lymphomas
presentation of acute leukaemias
marrow failure - anaemia, infections, bleeding
infiltration - hepatosplenomegaly, lymphadenopathy
features pointing towards acute lymphoblastic leukaemia
children
CNS involvement
features pointing towards acute myeloid leukaemia
> 60 years
gum infiltrates (monocytes)
less CNS involvement
common infections affecting those with acute leukaemias
bacterial septicaemia zoster CMV measles candidiasis pneumocystis pneumonia fungal
what does acute lymphoblastic leukaemia affect
B and T cell precursors - prevents maturation and differentiation producing immature blast cells
what does acute myeloid leukaemia affect
myeloid cell precursors - they proliferate but do not mature
what is a protein produced by immature lymphocytes and is a marker of ALL
TdT
what are histological features of acute leukaemia
large cells
high nuclear-cytoplasmic ration
prominent nucleoli
rapid proliferation
what are auer rods
pin shaped bodies seen in cytoplasm of myeloblasts in AML
presentation of chronic myeloid leukaemia
decreased weight tiredness fever sweats gout - purine breakdown bleeding abdominal discomfort (splenomegaly)
presentation of chronic lymphocytic leukaemia
may be asymptomatic
weight loss and night sweats if severe
enlarged rubbery non-tender lymph nodes
hepatosplenomegaly
first line test in leukaemia
blood count - high WCC
increased myeloid cells in CML (neutrophils, basophils, eosinophils etc)
high lymphocytes in CLL
blood film - look for blast cells, large cells, big nuclei, auer rod (AML)
diagnostic test in acute leukaemia
bone marrow biopsy - immunophenotyping to differentiate between myeloid and lymphoid
other investigations performed in ALL
CXR and CT Abdo - mediastinal and abdominal lymphadenopathy
lumbar puncture - CNS involvement
treatment of ALL
2-3 years multi-agent chemotherapy
treatment of AML
2-4 cycles of chemotherapy
5-10 days treatment followed by 2-4 weeks recovery
what are the 4 phases of ALL chemotherapy
induction
consolidation
intensification
maintenance
supportive treatment in ALL
blood/platelet transfusion
IV fluids
allopurinol (prevents tumour lysis syndrome)
Hickman line for IV access
biggest risk/complication of leukaemia and its treatment
infection - especially susceptible to fungal infections (take antifungal medication - itraconazole)
management of infection in leukaemia
immediately start IV broad spectrum antibiotics - do not wait for culture results
side effects of chemotherapy
nausea/vomiting hair loss liver/renal dysfunction tumour lysis syndrome (will occur during first course) infection fertility loss cardiomyopathy
what genetic mutation is seen in >80% of those with CML
Philadelphia chromosome - translocation between chromosome 9 and 22 which affects tyrosine kinae activity (oncogene)
treatment for CML
imatinib - tyrosine kinase inhibitor
imatinib side effects
nausea cramps oedema rash headache arthralgia
