Leukaemia

Question 1

What investigation gives a definitive diagnosis of leukaemia?

Answer 1

Immunophenotyping

Question 2

What are the investigations for leukaemia?

Answer 2

1 FBC + film
2 Coag screen
3 Immunophenotype biopsy
4 Genetics

Question 3

What is seen on marrow biopsy in acute leukaemia?

Answer 3

Greater than 20% blasts

Question 4

Blasts have an increased _____ : _____ ratio

Answer 4

Nuclear : cytoplasmic

Question 5

What are the 4 main types of leukaemia?

Answer 5

Acute myeloid
Acute lymphoblastic
Chronic myeloid
Chronic lymphocytic

Question 6

What type of blasts are seen in AML? How do they appear?

Answer 6

Myeloblasts
Big
Fine chromatin in nuclei
Prominent nucleoli

Question 7

What type of blasts are seen in ALL? How do they appear?

Answer 7

Lympoblasts
Coarse chromatin
Small nucleoli
Glycogen granules

Question 8

Aur rods are associated with what type of leukaemia?

Answer 8

AML

Question 9

What is the general pathology of acute leukaemia?

Answer 9

Blasts mutate in marrow - differentiation block - divide uncontrollably

Question 10

Why does acute leukaemia cause pancytopeania?

Answer 10

Blasts accumulate in marrow and take up space?

Question 11

Which part of the haematological system are involved in acute leukaemia?

Answer 11

Blood and marrow

Question 12

What type of leukaemia is most common in children? Which is most common in people over 60?

Answer 12

ALL children (think L for little people)
CLL 60+

Question 13

What are the risk factors for AML?

Answer 13

Downs
Radiation
MPD

Question 14

What is needed for a diagnosis of AML?

Answer 14

Always biopsy

Question 15

A subtype of AML called promyelocytic leukaemia is with t(15;17)and can cause …..

Answer 15

Coagulopathy eg ICH

Question 16

How may ALL present?

Answer 16

Marrow failure S+S
Lymphadenopathy
Hepatosplenomegaly
Testis / CNS involvement

Question 17

A subtype of AML it excess monocytes can cause what symptom?

Answer 17

Gum infiltration

Question 18

What is the management of acute leukaemia?

Answer 18

Triple agent chemotherapy

Via central Hickman line in children

Question 19

Which types of leukaemia can cause marrow failure?

Answer 19

Only acute leukaemia

Question 20

What is the general pathology of chronic leukaemia?

Answer 20

Uncontrolled proliferation but no differentiation or maturation block

Question 21

What stage of haematopoiesis are effected in CML?

Answer 21

Stem cells

Question 22

Which cells proliferate in CML?

Answer 22

Granulocytes
Granulocyte precursors
PLTs

Question 23

Which types of leukaemia is Down syndrome associated with?

Answer 23

AML and CML

Question 24

What are the 3 phases of CML?

Answer 24

Asymptomatic
Proliferative
Blast crisis (like AML)

Question 25

How might someone present in the asymptomatic and proliferative phases of CML?

Answer 25

``` Splenomegaly Gout Weight loss Sweats Fever ```

Question 26

What blood abnormalities are seen in the asymptomatic and proliferative phases of CML?

Answer 26

Normal or low Hb Granulo-philia +- raised PLTs

Question 27

What causes CML?

Answer 27

Philadelphia chromosome translocation t(9;22) produces BCR:ABL

Question 28

What is the management of CML?

Answer 28

Tyrosine kinase inhibitor imatinib | Example of molecular targeted therapy, chemo free treatment

Question 29

What cell types are effected in CLL?

Answer 29

Mature B lymphocytes | Escape apoptosis and arrested inbetween G0 and G1

Question 30

Which part of the haematological system are involved in CLL?

Answer 30

Blood + LNs

Question 31

How might CLL present?

Answer 31

Lymphadenopathy CAN IT CAUSE B CELL SYMPTOMS?

Question 32

What is the management of CLL?

Answer 32

Radiotherapy +- targeted therapies ALSO CHEMO??