Leukaemia Flashcards
Leukaemia
cancer of a particular line of stem cells in the bone marrow
4 types
AML
CML
ALL
AML
pancytopenia
low platelets
low RBC
low WBC
most common leukaemia in children under 5
ALL
typical features
fatigue fever failure to thrive pallor petechiae/abnormal bruising LN hepatosplenomegaly
petchiae differentials
leukaemia meningococcal septicaemia vasculitis NAI ITP HSP
diagnosis
FBC blood film lactate dehydrogenase bone marrow biopsy LN biopsy CXR, lumbar puncture, CT/MRI/PET
blood film
abnormal cells and inclusions
definitive diagnosis
bone marrow biopsy
bone marrow aspirate
liquid sample full of cells from bone marrow
bone marrow trephine
solid core sample of bone marrow and better assessment of cells and structure
where is bone marrow biopsy usually taken from?
iliac crest
what happens in ALL?
malignant change in lymphocyte precursor cells
acute proliferation of (usually) B lymphocytes
why is there pancytopenia in ALL?
B lymphocytes take over bone marrow and replace other cells
what is ALL often associated with?
downs syndrome
ionising radiation in pregnancy
ALL blood film
blast cells
ALL genetic association
philadelphia chromosome 30% adults but only 5% children
who is usually affected by CLL?
adults over 55
CLL symptoms
often asymptomatic
infections, anaemia, bleeding and weight loss
what can CLL cause?
warm autoimmune haemolytic anaemia
what can CLL transform into?
high grade lymphoma
richter’s transformation
blood film CLL
smear or smudge cells
3 phases of CML
chronic phase
accelerated phase
blast phase - crisis
how are those with CML often diagnosed?
asymptomatic raised WCC
characteristic cytogenic change CML
philadelphia chromosome
philadelphia chromosome
chr 9 and 22 translocation
CML
treating CML - what drug has revolutionalised treatment?
imatinib
BCR-ABL tyrosine kinase inhibitor
most common acute leukaemia in adults
ALL
what can ALL progress from?
myeloproliferative disorder
polycythaemia ruby vera
myelofibrosis
blood film AML
blast cells
auer rods in cytoplasm
how long is asymptomatic phase of CML?
5 years
complications of chemotherapy
failure stunted growth in children infections infertility tumour lysis syndrome neuro/cardiotoxicity
what causes tumour lysis syndrome?
release of uric acid from cells destroyed by chemo
impact of uric acid in TLS
crystals in interstitial tissue and tubules in kidney - AKI
treating tumour lysis syndrome
allopurinol or rasburicase
potassium and phosphate monitoring
calcium monitoring
Is CNS involvement common in ALL?
yes
3 classifications of ALL
morphological - FAB
cytogenic - philadelphia
immunological
ALL treatment
remission
consolidation
CNS prophylaxis
maintenance
ALL cure rate children
70-90%
only cure for CML
stem cell transplant -HLA matched
treating CLL
fludarabine
rituximab
cyclophosphamide
staging for CLL
binet staging
rai stage
binet staging
A = fewer 3 LN B = >3 LN C = anaemia and low platelets
