Leukaemia

Question 1

Presentation of leukaemia (8)

Answer 1

Fatigue

Fever

Failure to thrive (children)

Pallor due to anaemia

Petechiae and abnormal bruising due to thrombocytopenia

Abnormal bleeding

Lymphadenopathy

Hepatosplenomegaly

Question 2

avg ages of different leukaemias

Answer 2

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 3

Differential Diagnosis of Petechiae

Answer 3

Leukaemia

Meningococcal septicaemia

Vasculitis

Henoch-Schonlein Purpura (HSP)

Idiopathic Thrombocytopenia Purpura (ITP)

Non-accidental injury

Question 4

Investigations for leukaemia (8)

Answer 4

Full blood count

Blood film

Lactate dehydrogenase (LDH) - often raised in leukaemia

Bone marrow biopsy

CXR

Lymph node biopsy

Lumbar puncture

CT, MRI and PET

Question 5

Acute Lymphoblastic Leukaemia

Answer 5

Malignant change in one of the lymphocyte precursor cells

Acute proliferation of a single type of lymphocyte (usually B-lymphocytes)

Often associated with Downs syndrome
Blood film shows blast cells
Associated with the Philadelphia chromosome (t(9:22) translocation) in 30% of adults

Question 6

Chronic Lymphocytic Leukaemia

Answer 6

Chronic proliferation of a single type of well differentiated lymphocyte (usually B-lymphocytes)

Can cause warm autoimmune haemolytic anaemia
Can transform into high-grade lymphoma - Richter’s transformation

Blood film shows “smear” or “smudge” cells

Question 7

Three typical phases of Chronic Myeloid Leukaemia

Answer 7

Chronic phase (5 years - often asymptomatic)

Accelerated phase (abnormal blast cells take up a high proportion of the cells in the bone marrow and blood - patients become symptomatic)

Blast phase (even higher proportion of blast cells and blood [>30%] severe symptoms and pancytopenia. It is often fatal

Question 8

What translocation is associated with CML

Answer 8

Philadelphia chromosome

Translocation of genes between chromosome 9 and 22

t(9:22) translocation

Question 9

Acute Myeloid Leukaemia

Answer 9

Most common acute leukaemia in adults

Can be the result of a transformation from a myeloproliferative disorder such as polycythaemia ruby vera or myelofibrosis

Blood film - blast cells. These blast cells can have rods inside their cytoplasm that are named Auer rods

Question 10

Management of leukaemia

Answer 10

Usually trteated with chemotherapy and steroids

Other therapies include:

Radiotherapy
Bone marrow transplant
Surgery

Question 11

Complications of Chemotherapy

Answer 11

Failure

Stunted growth and development in children

Infections due to immunodeficiency

Neurotoxicity

Infertility

Secondary malignancy

Cardiotoxicity

Tumour lysis syndrome

Question 12

Tumour Lysis Syndrome

Answer 12

Caused by the release of uric acid from cells that are being destroyed by chemotherapy

Can form crystals in the interstitial tissue and tubules of the kidneys and causes acute kidney injury

Allopurinol or rasburicase are used to reduce the high uric acid levels

Potassium and phosphate are also released so these need to be monitored
High phosphate can lead to low calcium