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Systems- Haematology > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

What type of stem cell do lymphoid and myleoid progenitor cells differentiate from?

A

Haematopoiteic

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2
Q

Which type of cells are affeted in ALL?

A

Lymphoid progenitors

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3
Q

What type of cells are affected in CLL?

A

Lymphocyets

B&T cells

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4
Q

What type of cells are affected in AML?

A

Myleoid progenitors

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5
Q

What type of cells are affected in myeloproliferative disorders?

A

Cells differentiatesd from myeloid progenitors

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6
Q

What type of leukaemia is associated with downs syndrome?

A

ALL

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7
Q

What type of leukaemia is most common in children?

A

ALL

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8
Q

What is the difference between acute and chronic leukaemia in terms of:

A. Maturity of cells affected

B. Ablility of cells affected to differentiate

C. Progression

D. Blastic or cytic

A

A

Acute -> immature (hence progenitor cells)

Chronic -> mature

B

Acute -> can’t differentiate

Chronic -> can differentiate

C

Acute -> rapid

Chronic -> gradual

D

Acute -> blastic

Chronic -> cytic

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9
Q

Myleoid leukaemias result in an increase in WCC (hyperleuckocytosis), which can cause hyperviscoity. What are the clinical features of this?

A

Retinal haemorrhages

Venous congestion

Altered concioussness

Headaches

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10
Q

What is the main cause of AML?

A

Acquired (somatic) mutations

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11
Q

Is there a familial risk of AML?

A

No, as the mutations or somatic

(although Li Fraumeni syndrome can increase your risk)

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12
Q

What syndrome results in inherited p53 gene, which increases you risk of devleoping several cancers?

A

Li Fraumeni syndrome

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13
Q

At what age are you most at risk of AML?

A

Old (>60)

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14
Q

Cytogeneitcs and karyotyping are both investigations used for AML which look at chromosomes. What are some chromosomal mutations that can cause AML?

A

t(8,21)

Inversion 16 (has a good prognosis)

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15
Q

What type of stem cell transplants are used to treat AML and where do these stem cells come from?

A

Allogenic

The stem cells come from a donor (e.g. sibling)

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16
Q

If a donor of an allogenic stem cell transplant has an allergy, what is the significance of this for the recipient?

A

They will likely devlop the allergy too

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17
Q

Is AML cureable in older people?

A

No

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18
Q

What would older patients with AML become dependent on?

A

Blood transfusions

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19
Q

If AML relapses after chemo, what is the next line treatment?

A

Allogenic stem cell transplant

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20
Q

What is a common example of chemotherapy used in AML?

A

Azocytozine

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21
Q

What are some of the clinical features of AML?

A

Anaemia

Mucosal bleeding

Brusing

Frequent infections

Bone pain

Splenomegaly

Fatigue

Malaise

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22
Q

Anaemia, mucosal bleeeding, bruising and frequent infections are all clinical features of AML. What aspect of AML results in these faetures?

A

Bone marrow failure

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23
Q

Bone pain and splenomegaly are clinical features of AML. What aspect of AML result in these features?

A

Hyperleucocytosis

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24
Q

What are some of the causes of AML?

A

Myelodysplasia

Previous chemotherapy

Exposure to benzene or ionising radiation

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25
Q

Exposure to what can increase your risk of AML?

A

Benzene

Ionising radiation

(always ask about these in the history)

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26
Q

What are the investigations used for AML?

A

Bone marrow aspirate

Trephine biopsy

Blood films

Cytogenetics

Immunophenotyping

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27
Q

What are the signs seen on a blood film for AML?

A

Auer rods

Bi-lobular nuclei

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28
Q

How can you get

A
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29
Q

What biopsy is used to get a sample of bone marrow which can be used to make blood films?

A

Trephine

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30
Q

On a bone marrow aspirate, what % of marrow cells will be leukemic blasts?

A

>20%

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31
Q

What investigation is undergone to determine the type of AML?

A

Immunophenotyping

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32
Q

What is the 1st line treatment for AML?

A

Chemotherapy

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33
Q

What are the treatments for AML?

A

Supportive therapy

Chemotherapy

Allogenic stem cell transplant

Antibiotic and antifungal prophylaxis

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34
Q

What prophylaxis are patients with AML given?

A

Antibacterial and antifungal

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35
Q

What is involved in supportive treatment for AML?

A

RBC and platlet transfusion

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36
Q

What is the main curative treatment of AML?

A

Allogenic stem cell transplant

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37
Q

In young patients with AML, what is always considered 1st line?

A

Allogenic stem cell transplants

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38
Q

What are some of the clinical features of CML?

A

Splenomegaly

Anaemia

Mucosal bleeding

Weight loss

Gout

Hyperleucocytosis

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39
Q

What are some complications of chemotherapy?

A

Neutropenic sepsis

Tumuour lysis syndrome

Mucositis

Infertility

Secondary malignancy

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40
Q

Tumour lysis syndrome is a poteneital complication of chemotherapy. Levels of what blood test resutls woudl be increased?

A

Urate

Potassium

Phosphate

41
Q

What investigatiosn are used for CLL?

A

Bone marrow aspirate

Blood films

Immmunophenotypign

Cytogenetics

42
Q

What chromosome should you look for on cytogenetics in CLL?

A

Philadelphia chromosmoe

43
Q

What type of immunotherapy can be used to treat CML?

A

Tyrosine kinase inhibitors

44
Q

What is a subtype of AML that is a clinical emrgency and needs urgent treatment?

A

Acute Promyleocytic laeukemia (APML or APL)

45
Q

What is AML stand for?

A

Acute myleoid leukemia

46
Q

What does CML stand for?

A

Chronic myeloid leukemia

47
Q

What does ALL stand for?

A

Acute lymphoblastic leukemia

48
Q

What does CLL stand for?

A

Chronic lymphocytic leukemia

49
Q

What blood probelm is APML associoated with?

A

Coagulopathy

50
Q

How can APML present?

A

Mucosal bleeding and burising

(just classic bone marrow falure stuff ehhh)

51
Q

What is the prognosis of APML?

A

Very good

Providing its treated early and the paient survives the initial stages

52
Q

What are the 2 treatments used to treat APML?

A

All-trans Retinoic Acid (ATRA)

Arsenic trixoide

53
Q

What is the difference in the number of cells needed on a sample from a bone marrow aspirate to diagnose ALL and AML?

A

ALL -> >20% lymphobasts

AML -> >20% myleoblasts

(same number needed yall)

54
Q

Leukemia can obvs cause bone marrow failure, which results in thrombocytopneia, anameia and nuetropenia. What is the name of this triad?

A

Pancytopenia

55
Q

What are the 5 phases of chemotherapy?

A
  1. Induction
  2. Consolidation
  3. Interim maintenance
  4. Delayed intensification
  5. Maintenance
56
Q

What are some of the clinical features of ALL?

A

Musocsal bleeding

Bone pain (limping)

Retinal haemorrhages

Fatigue

Weight loss

Spleomegaly

Anaemia

57
Q

What investigations are used for ALL?

A

Bone marrow aspirate

Blood film

FBC

Cytogenetics

Gene testing

58
Q

What genes/chromosomes are associated with ALL?

A

CD19

p53

Philadelphia chromosome

59
Q

What are the treatments for ALL?

A

Chemotherapy

Radiotherapy

Allogenic stem cell transplants

Chimeric antigen receptor T-cells (CAR-T cells)

60
Q

What type of immunotherapy can be used to treat ALL?

A

Chimeric antigen receptor T-cells (CAR-T cells)

61
Q

What will you look for on blood tests for bone marrow failure, which occurs in all types of leukaemia?

A

Low RBC count

High neutrophil count

Low platelet count

62
Q

What is the commonest type of leukaemia?

63
Q

How does CLL usulaly present?

A

Asymtpomatically

64
Q

What sex is more at risk of CLL?

65
Q

What are the indications for treating CLL?

A

Progressive bone marrow failure

B-symptoms

Large splenomegaly

66
Q

B-symtpoms can occur in ALL and CLL. What are they?

A

Weight loss (>10% of TBW)

Fatigue

Drenching night sweats

Puritis

Unexplanined fever

67
Q

In children, how does ALL commonly present?

A

Limping (due to bone pain)

Unprovoked nose bleeds

Bleeding when brushing teeth

Bruising

Pallor

Lymphadenopathy

Hepatosplenomegaly

68
Q

Which syndrome increases your risk of developing ALL?

A

Downs syndrome

69
Q

When a child presents with mucosal bleeding, ALL is suspected. What are thr differentials?https://www.brainscape.com/decks/9139186/cards/new

A

VWB disease

Immune thrombocytopenic purpura

Hamolytic uremic syndrome

Aplastic anaemia

71
Q

If ALL is suspected in children, who must you refer them to?

A

Paediatric oncologist

72
Q

What are the different ways of admisitering chemotherapy?

A

IV

Intrathecal

73
Q

For ALL, which treatment is used for induction and what is given as maintanance?

A

Induction -> chemo

Maintenance -> methotrexate

74
Q

What chromomosomes (that are present on cytogenetics) associted with ALL in adults and in children?

A

Adults -> t(9,22)

Children -> t(12,21)

75
Q

‘Sanctuary sites’ are areas of the body that chemotherapy has no affect. What are 2 examples of these sites?

A

Central nervous system (chemo drugs don’t cross the BBB)
Testes

76
Q

What does the prognois of ALL depend on?

A

Age

WCC at presentation

CNS involvement

Response to chemotherapy

Cytogenetics

77
Q

What are some of the early complications of chemotherapy?

A

Neurtopenic sepsis

Tumuor lysis syndrome

Hair loss

Mucositis

78
Q

What are some of the late complications of ALL?

A

Growth delay

Secondary malignancy

Infertiliy

Hypothyroidism

Pulmonary fibrosis

79
Q

What type of lymphadenopathy does leukaemia cause?

A

Painless generalised lymphadenopathy

80
Q

Which type of leukaemia can cause ‘massive’ splenomegaly?

81
Q

What is a potential complication of a trephine biopsy?

82
Q

What lymphoid cells are mainly affected in CLL?

A

B-memory cells

83
Q

What immune disorder that affects clotting can be caused by CLL?

A

Immune Thrombocytopenic Purpura (ITP)

84
Q

Patients on chemo can often get a side effect of numbness and tingling in their fingers and toes, what is this called?

A

Peripheral neuropathy

85
Q

Patietns on chemo often get a side effect that involves a rash that has a dermatomal spread, what is this rash called?

86
Q

What is the difference between acute leukaemia and chronic leukaemia regarding it’s onset?

A

Acute -> sudden (1-4 weeks)

Chronic -> Insidious (months)

87
Q

What cells are affected by AML and ALL?

A

AML -> Common myeloid progenitors

ALL -> Common lymphoid progenitors

88
Q

What cells proliferate like mad in AML?

A

Myleoblasts

89
Q

What lab tests can be done to help when diagnosing lekaaemia?

A

Morphology

Immunophenotyping

Cytogentic analysis

Molecular analysis

90
Q

What prophylactic treatment will patient with leukemia be on and give examples.

A

Anti-viral -> aciclovir

Anti-bacterial -> cirpoloxacin

Anti-fungal -> Ambisome

91
Q

Before giving steroids (e.g. dexamethasone) what condition do you always need to check for and what would you measure?

A

Tumour lysis syndrome

By measuring…

Phosphate levels

Potassium levels

Urate levels

(all would be increased)

92
Q

What is the most common type of leaukemia in adults?

93
Q

Why is Down’s syndrome associated with leukaemia?

A

As triosomy 21 can cause bone marrow damage

94
Q

What 2 types of leukaemia are associated with Downs?

A

ALL (mainly)

AML

95
Q

What staging system is used for CLL?

A

Binet staging

96
Q

For leukemia, what is the most common type of chemo drug used to treat it?

97
Q

What is the commest cause of CLL?

A

Actue haemolytic anaeamia

98
Q

What is Rituximab?

A

Anti-CD20 chemo drug

Systems- Haematology (26 decks)

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