Leukaemia

Question 1

Clinical Features

Answer 1

Presentation of leukaemia is quite non-specific:

• Fatigue
• Fever
• Failure to thrive (children)
• Pallor due to anaemia
• Petechiae and abnormal bruising due to thrombocytopenia
• Abnormal bleeding
• Lymphadenopathy
• Hepatosplenomegaly

Question 2

Differentials for bruising and petechiae

Answer 2

Leukaemia
Meningococcal septicaemia
Vasculitis
Henoch-Schonlein Purpura (HSP)
Idiopathic Thrombocytopenia Purpura (ITP)
Non-accidental injury

Question 3

Chronic Myeloid Leukaemia

Clinical features

Clinical course

Cause

Management

Answer 3

Clinical features: normal vague + splenomegaly

Chronic phase: can last up to 5 years, usually asymptomatic
Accelerated phase: become more symptomatic
Blast phase: blast cells over 30%, severe symptoms, often fatal

Cause: Philadelphia chromosome, which is a translocation of genes between chromosome 9 and 22: it is a t(9:22) translocation resulting in BCR-ABL gene

Management: Imatinib

Question 4

Ages (not definite, rough guide)

Answer 4

[ALL CeLLmates have CoMmon AMbitions]

Under 5 and over 45 – acute lymphoblastic leukaemia (ALL)
Over 55 – chronic lymphocytic leukaemia (CeLLmates)
Over 65 – chronic myeloid leukaemia (CoMmon)
Over 75 – acute myeloid leukaemia (AMbitions)

Question 5

Chronic Lymphocytic Leukaemia

Clinical Features

Diagnosis

Complications

Answer 5

CLINICAL FEATURES: lymphadenopathy more marked than CML

DIAGNOSIS:
- Blood film: SMUDGE cells which is the fragile lymphocytes being smeared

COMPLICATIONS:

• anaemia
• hypogammaglobulinaemia leading to recurrent infections
• warm autoimmune haemolytic anaemia in 10-15% of patients (mx: prednisolone)
• transformation to high-grade lymphoma (RICHTER’S transformation)

Question 6

Acute Myeloblastic Leukaemia

Risk factors

Pathology

Notable type

Answer 6

PATHOLOGY: may occur as a primary disease or following a secondary transformation of a myeloproliferative disorder

RISK FACTORS:
- myelodysplasia

DIAGNOSIS:
- blood film showing AUER RODS

TYPE:
ACUTE PROMYELOCYTIC LEUKAEMIA (APML) M3
- associated with t(15;17) = fusion of PML and RAR-alpha genes
- presents younger than other types of AML (average = 25 years old)
- associated with DISSEMINATED INTRAVASCULAR COAGULATION

Question 7

Acute Lymphoblastic Leukaemia

Type

Epidemiology

Associated with

Management

Answer 7

COMMON TYPE:
- It causes acute proliferation of a single type of lymphocyte, usually B-lymphocytes.
(T cell ALL = poor prognosis)

Most common cancer in children and peaks around 2-4 years. It can also affect adults over 45.

Associated with DOWN’S SYNDROME

Blood film shows blast cells

Management: whole brain and testes irradiation

Question 8

Management

Brief overview

Answer 8

Treatment will be coordinated by an oncology multi-disciplinary team. Leukaemia is primarily treated with chemotherapy and steroids.

Other therapies include:

Radiotherapy
Bone marrow transplant
Surgery

Question 9

Diagnosis approach

Answer 9

FBC, LDH

Blood film

Bone marrow biopsy

Lymph node biopsy to rule out lymphoma

Staging CT CAP