Leukaemia - General

Question 1

What are the 4 main types of Leukaemia? What are the age distributions of these Leukaemias?

Answer 1

1. Acute Lymphoblastic Leukaemia (ALL) <5 and >45.
2. Chronic Lymphocytic Leukaemia (CLL) - 55+.
3. Acute Myeloid Leukaemia (AML) 75+.
4. Chronic Myeloid Leukaemia (CML) 65+

Question 2

Pathophysiology of Leukaemia.

Answer 2

A genetic mutation in one of the precursor cells in the bone marrow, leads to excessive production (cancer) of a single type of abnormal WBCs.

Question 3

What is the effect of Leukaemia?

Answer 3

Excessive production of a single type of cell can lead to suppression of the other cell lines, causing underproduction of other cell types = pancytopenia (anaemia, leukopenia, thrombocytopenia).

Question 4

Clinical Features of Leukaemia (General) (8).

Answer 4

1. Non-Specific.
2. Fatigue.
3. Fever.
4. Failure to Thrive.
5. Pallor (Anaemia).
6. Petechiae and Abnormal Bruising (Thrombocytopenia).
7. Lymphadenopathy.
8. Hepatosplenomegaly.

Question 5

Petechiae - Definition & Aetiology.

Answer 5

Bleeding under the skin, caused by thrombocytopenia.

Question 6

Differential Diagnosis of Petechiae (6).

Answer 6

1. Leukaemia.
2. Meningococcal Septicaemia.
3. Vasculitis.
4. Henoch-Schonlein Purpura (HSP).
5. Idiopathic Thrombocytopenic Purport (ITP).
6. Non-Accidental Injury (Kids + Vulnerable Adults).

Question 7

Investigations of Leukaemia (7).

Answer 7

1. FBC - Initial (within 48 hours if suspected).
2. Blood Film - Abnormal Cells + Inclusions.
3. LDH - Lactate Dehydrogenase (Raised).
4. Bone Marrow biopsy (definitive diagnosis).
5. CXR - Infection/Mediastinal Lymphadenopathy.
6. Lumbar Puncture - CNS Involvement.
7. CT/MRI/PET - Staging.

Question 8

Paediatric Leukaemia - Referral.

Answer 8

Children or young adults with petechiae/hepatosplenomegaly should be referred IMMEDIATELY to hospital.

Question 9

What is a Bone Marrow Aspiration?

Answer 9

A liquid sample full of cells from within the bone marrow - can be examined straight away.

Question 10

What is a Bone Marrow Trephine?

Answer 10

A solid core sample of the bone marrow and provides a better assessment of the cells and the structure - requires a few days of preparation.

Question 11

What is a Bone Marrow Biopsy?

Answer 11

Taken from iliac crest - involving LA and a specialist needle.

Question 12

Management of Leukaemia (3).

Answer 12

1. Oncology MDT.
2. Chemotherapy + Steroids = Primary Mode.
3. Radiotherapy, Bone Marrow Transplant, Surgery = Other Therapies.

Question 13

Complications of Chemotherapy (8).

Answer 13

1. Failure.
2. Stunted Growth/Development.
3. Infections (Immunodeficiency).
4. Neurotoxicity.
5. Infertility.
6. Secondary Malignancy.
7. Cardiotoxicity.
8. Tumour Lysis Syndrome.