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Haematology Week 3 > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

What is an acute leukaemia?

A

Rapidly progressive clonal malignancy of the marrow/blood with maturation defects

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2
Q

Acute leukaemia is defined as an excess of what?

A

‘Blasts’, by > 20% in the peripheral blood or bone marrow

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3
Q

Acute leukaemias will cause a decrease/loss of normal haemopoietic reserve. What clinical features will this cause?

A

Anaemia, thrombocytopenia, neutropenia

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4
Q

What are the two main subtypes of acute leukaemia?

A

Acute myeloid leukaemia and acute lymphoblastic leukaemia

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5
Q

ALL is a disease of what?

A

Primitive lymphoid cells, i.e. lymphoblasts

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6
Q

What is the most common childhood cancer?

A

Acute lymphoblastic leukaemia

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7
Q

What are the 4 main presenting features of acute lymphoblastic leukaemia?

A

Marrow failure, leukaemic effects, infiltration (hepatosplenomegaly and superficial lymphadenopathy) and bone pain

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8
Q

ALL can present with ‘leukaemic effects’ - what is meant by this?

A

There are high counts of leukaemic cells in the blood. This can cause obstruction of circulation, and also involvement of areas outside the marrow and blood such as the CNS or testis

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9
Q

Acute myeloid leukaemia is more common in who?

A

Elderly (> 60)

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10
Q

How can acute myeloid leukaemia arise?

A

De novo, or secondary to an underlying haematological disorder

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11
Q

What is the presentation of AML?

A

Marrow failure

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12
Q

Subgroups of AML can have characteristic presentations. What are some examples of these?

A

DIC or gum infiltration

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13
Q

What are the 3 main investigations for acute leukaemia?

A

Blood count and film, coagulation screen, bone marrow aspirate

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14
Q

In acute leukaemia, what will a blood count and film show?

A

Reduction in normal, presence of abnormal, lots of large primitive cells

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15
Q

Auer Rod cells are seen in what type of malignancy?

A

Acute myeloid leukaemia

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16
Q

How can ‘blasts’ be identified on a blood film?

A

High nuclear: cytoplasmic ratio

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17
Q

What are the main things to do with a bone marrow aspirate for acute leukaemia?

A

Morphology and immunophenotyping

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18
Q

What investigation is required for a definitive diagnosis of acute leukaemia?

A

Immunophenotyping from a bone marrow aspirate

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19
Q

What is the purpose of cyto/molecular genetics in the diagnosis of acute leukaemia?

A

Prognostic significance

20
Q

When is a trephine (piece of bone) used to help diagnose acute leukaemia?

A

If the aspirate is sub-optimal

21
Q

What is the main treatment of acute leukaemias?

A

Multi agent chemotherapy

22
Q

How is chemotherapy performed for ALL?

A

Can last 2-3 years with different phases of varying intensity

23
Q

How is chemotherapy performed for AML?

A

Intensive - 2-4 cycles of 5-10 days of chemo followed by 2-4 weeks recovery

24
Q

What are the main problems of marrow suppression in terms of treatment for acute leukaemia?

A

Anaemia, neutropenia (infections) and thrombocytopenia (bleeding)

25
Q

What type of organisms can cause fulminant life-threatening sepsis in neutropenic patients?

A

Gram -

26
Q

Apart from marrow suppression, what are some complications of treatment for acute leukaemia?

A

N+V, hair loss, liver/renal dysfunction, tumour lysis syndrome, infections

27
Q

What are some late effects of treatment for acute leukaemia?

A

Loss of fertility and cardiomyopathy with anthracyclines

28
Q

If there is a neutropenic fever in a patient receiving treatment for acute leukaemia, what is the management?

A

Empirical treatment with broad spectrum antibiotics, particularly covering gram - organisms

29
Q

What may you suspect if there has been prolonged neutropenia and persistent fever unresponsive to antibiotics?

A

Fungal infection

30
Q

What are the outcomes of acute myeloid leukaemia?

A

Many patients will go into remission, but many will relapse

31
Q

Apart from chemotherapy, what are some other treatment options for acute myeloid leukaemia?

A

Targeted treatments and allogenic stem cell transplantation

32
Q

Molecular targeting with kinase inhibitors can be used as a treatment in what?

A

ALL with the Philadelphia chromosome

33
Q

What are the outcomes of acute lymphoblastic leukaemia?

A

70-90% cure rate with chemotherapy in children

34
Q

What is the pathology behind chronic myeloid leukaemia?

A

Uncontrolled proliferation of myeloid cells (granulocytes and their precursors, other lineages e.g. platelets)

35
Q

Stem cell transplants are not usually done in who?

A

Patients aged > 60

36
Q

In acute leukaemia, the cells do not mature. What happens in chronic leukaemia?

A

The cells mature, but there are too many of them

37
Q

Describe the onset of clinical features in chronic myeloid leukaemia?

A

Mostly chronic and insidious

38
Q

How is chronic myeloid leukaemia often picked up?

A

On routine bloods (the patient is asymptomatic)

39
Q

What are some clinical features of chronic myeloid leukaemia?

A

Splenomegaly, hypermetabolic features (weight loss, fever, sweats), gout, priapism

40
Q

Who does chronic myeloid leukaemia tend to occur in?

A

People aged 40-60, with a male predominance

41
Q

What happens to the blood count in chronic myeloid leukaemia?

A

Reduced/normal Hb, leucocytosis (neutrophilia, eosinophilia, basophilia), thrombocytosis

42
Q

What is a bone marrow biopsy used for in chronic myeloid leukaemia?

A

To check for the presence of ‘blasts’ which would be suggestive of AML

43
Q

What is the hallmark of chronic myeloid leukaemia?

A

The Philadelphia chromosome

44
Q

What change occurs to form the Philadelphia chromosome?

A

A translocation between chromosomes 9 and 22, resulting in a new gene known as BCR-ABL1

45
Q

The Philadelphia chromosome causes the formation of the BCR-ABL1 gene - what is the product of this?

A

A tyrosine kinase

46
Q

What is the treatment for patients with chronic myeloid leukaemia? What type of drug is this?

A

Imatinib / tyrosine kinase inhibitor

47
Q

What is the outcome for patients with chronic myeloid leukaemia?

A

Normal life expectancy with imatinib treatment

Haematology Week 3 (9 decks)

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