Leukaemia

Question 1

What is leukaemia?

Answer 1

Malignant neoplastic process involving one of the white blood cell lines (neutrophils, lymphocytes, monocytes etc). It could be classified into Myeloid (neutrophils) or Lymphocytic (lymphocytes) leukaemias.

Question 2

What does a blood film show in acute leukaemia?

Answer 2

If it is dominated by the immature cells or blast cells and they will be referred to as acute “myeloblastic” or “lymphoblastic” leukaemias

Question 3

What are signs of leukaemia?

Answer 3

anaemia and/or thrombocytopenia, bleeding gums, ecchymoses, rash

Question 4

What are the features of chronic leukaemia?

Answer 4

more mature cells (neutrophils or lymphocytes) will be seen in excess number

Question 5

What are the most common forms of leukaemia in children?

Answer 5

Acute leukaemias (AML or ALL)

Question 6

What are purpura?

Answer 6

The appearance of non-blanching red spots on the skin. They are caused by small areas of bleeding under the skin. Usually purpura are <1cm. Larger bleeds are referred to as echymoses.

Question 7

What are the differentials for sudden onset gum bleeding/purpurae, echymoses in young patients?

Answer 7

thrombotic thrombocytopenic purpura

haemolytic uraemic syndrome

meningoccocal sepsis

leukaemia

Question 8

When should TTP and HUS be considered?

Answer 8

in patients who present with purpura and urinary manifestations such as haematuria or oliguria

Question 9

What is treatment for acute myeloblastic leukaemia?

Answer 9

Chemotherapy

Question 10

What would be seen on a FBC for AML?

Answer 10

A raised WCC (raised neutrophils)

Low Hb, haematocrit and platelets

Question 11

What is Ritcher’s transformation?

Answer 11

Leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma

Question 12

What is the characteristic blood film finding of CLL?

Answer 12

Smudge/smear cells

Question 13

What is characteristic blood film finding of CML?

Answer 13

Pseudo Pelger-Huet cells

Question 14

What are the clinical features of AML?

Answer 14

Bone marrow failure –>

anaemia: pallor, lethargy, weakness
neutropenia: whilst white cell counts may be very high, functioning neutrophil levels may be low leading to frequent infections etc
thrombocytopenia: bleeding
splenomegaly
bone pain

Question 15

What is ALL?

Answer 15

Acute lymphoblastic leukaemia (ALL) is the most common malignancy affecting children and accounts for 80% of childhood leukaemias. The peak incidence is at around 2-5 years of age and boys are affected slightly more commonly than girls

Question 16

What are signs of ALL?

Answer 16

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae