Leukaemia Flashcards
What investigation gives a definitive diagnosis of leukaemia?
Immunophenotyping
What are the investigations for leukaemia?
1 FBC + film
2 Coag screen
3 Immunophenotype biopsy
4 Genetics
What is seen on marrow biopsy in acute leukaemia?
Greater than 20% blasts
Blasts have an increased _____ : _____ ratio
Nuclear : cytoplasmic
What are the 4 main types of leukaemia?
Acute myeloid
Acute lymphoblastic
Chronic myeloid
Chronic lymphocytic
What type of blasts are seen in AML? How do they appear?
Myeloblasts
Big
Fine chromatin in nuclei
Prominent nucleoli
What type of blasts are seen in ALL? How do they appear?
Lympoblasts
Coarse chromatin
Small nucleoli
Glycogen granules
Aur rods are associated with what type of leukaemia?
AML
What is the general pathology of acute leukaemia?
Blasts mutate in marrow - differentiation block - divide uncontrollably
Why does acute leukaemia cause pancytopeania?
Blasts accumulate in marrow and take up space?
Which part of the haematological system are involved in acute leukaemia?
Blood and marrow
What type of leukaemia is most common in children? Which is most common in people over 60?
ALL children (think L for little people) CLL 60+
What are the risk factors for AML?
Downs
Radiation
MPD
What is needed for a diagnosis of AML?
Always biopsy
A subtype of AML called promyelocytic leukaemia is with t(15;17)and can cause …..
Coagulopathy eg ICH
How may ALL present?
Marrow failure S+S
Lymphadenopathy
Hepatosplenomegaly
Testis / CNS involvement
A subtype of AML it excess monocytes can cause what symptom?
Gum infiltration
What is the management of acute leukaemia?
Triple agent chemotherapy
Via central Hickman line in children
Which types of leukaemia can cause marrow failure?
Only acute leukaemia
What is the general pathology of chronic leukaemia?
Uncontrolled proliferation but no differentiation or maturation block
What stage of haematopoiesis are effected in CML?
Stem cells
Which cells proliferate in CML?
Granulocytes
Granulocyte precursors
PLTs
Which types of leukaemia is Down syndrome associated with?
AML and CML
What are the 3 phases of CML?
Asymptomatic
Proliferative
Blast crisis (like AML)
How might someone present in the asymptomatic and proliferative phases of CML?
Splenomegaly Gout Weight loss Sweats Fever
What blood abnormalities are seen in the asymptomatic and proliferative phases of CML?
Normal or low Hb
Granulo-philia
+- raised PLTs
What causes CML?
Philadelphia chromosome translocation t(9;22) produces BCR:ABL
What is the management of CML?
Tyrosine kinase inhibitor imatinib
Example of molecular targeted therapy, chemo free treatment
What cell types are effected in CLL?
Mature B lymphocytes
Escape apoptosis and arrested inbetween G0 and G1
Which part of the haematological system are involved in CLL?
Blood + LNs
How might CLL present?
Lymphadenopathy
CAN IT CAUSE B CELL SYMPTOMS?
What is the management of CLL?
Radiotherapy +- targeted therapies
ALSO CHEMO??
