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Haematology > Leukaemia, Lymphoma and Myeloma > Flashcards

Leukaemia, Lymphoma and Myeloma Flashcards

1
Q

A child presents with anaemia, neutropenia and thrombocytopenia. What is the likely diagnosis?

A

Acute lymphoblastic leukaemia.

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2
Q

A 55 year old man is investigated for suspected anaemia. He is found to have anaemia and lymphoctytosis on FBC. Blood film reveals smudge cells. What is the likely diagnosis?

A

Chronic lymphocytic leaukaemaia

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3
Q

A person with CLL gets recurrent infections. What is the likely complication that occured?

A

Hypogammaglobulinaemia

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4
Q

An individual with CLL develops anaemia with reticulocytosis, raised LDH and jaundice.

What is the likely diagnosis and treatment?

A

Warm autoimmune haemolytic anaemia

Treat CLL, then steroids +/- ritixumab

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5
Q

What is Richter’s transformation?

A

When a CLL patient develops high-grade non-Hodgkin’s lymphoma.

This makes them very unwell suddenly.

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6
Q

A 70 year old man develops anaemia, weight loss and splenomegaly. On FBC granulocytosis and thrombocytosis is seen. Blood film reveals granulocytes at different stages of maturation. What is the likely diagnosis?

A

Chronic myeloid leukaemia

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7
Q

What is first-line treatment for CML? How does it work?

A

Imatinib - tyrosine kinase inhibitor.

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8
Q

A 70 year old man, who previously is known to have a myeloproliferative disorder, develops anaemia, neutropaenia, thrombocytopenia and splenomegaly. What is the likely diagnosis?

A

Acute myeloid leukaemia

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9
Q

Auer rods are seen on blood film. What is the likely diagnosis?

A

Acute myeloid leukaemia

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10
Q

What leukaemia are smear cells seen in?

A

Chronic lymphocytic leukaemia

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11
Q

What is bone marrow failure?

A

Inability for bone marrow to produce blood cells:

Anaemia - low Hb
Infections - low neutrophils
Bleeding - low platelets

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12
Q

What is the 4 approaches to management of acute lymphoblastic leukaemia?

A

Supportive - fluids, transfusion, allopurinol (to avoid TLS)

Infective - start prophylactic antibiotics, antifungals and antivirals due to neutropenia.

Chemotherapy (vincristine)

Matched related allogenic stem cell transplant (after 1st remission in younger patients)

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13
Q

What is the management of acute myeloid leukaemia?

A

Supportive - fluids, transfusion, allopurinol (to avoid TLS)

Infective - start prophylactic antibiotics, antifungals and antivirals due to neutropenia.

Chemotherapy (daunorubicin)

Bone marrow transplant (ciclosporin + methotrexate for graft vs host disease prophylaxis)

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14
Q

What are the 4 approaches to management of chronic lymphocytic leukaemia?

A

If symptomatic: fludarabine + rituximab +/- cyclophosphamide

Radiotherapy - for lymphadenopathy and splenomegaly

Stem-cell transplant - only in selected patients

Supportive - transfusions and IVIg if hypogammaglobulinaemia

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15
Q

What is the prognosis for ALL?

A

Most children are cured. Nearly half of adults are cured.

Poor prognosis if relapsed.

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16
Q

What is the prognosis of CML?

A

Median survival of 5-6 years

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17
Q

What is the prognosis of CLL?

A

Rule of 3rds:
1/3 never progress
1/3 progress slowly
1/3 progress rapidly

Death is usually due to infection or Richter’s transformation

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18
Q

What electrolyte disturbances are seen in tumour lysis syndrome?

A

High urate
High K+
High phosphate
Low Ca2+

19
Q

How is tumour lysis syndrome managed?

A

Prophylaxis - allopurinol

Acutely - hydration and urolytics (rasburicase, allopurinol)

20
Q

What are the 3 mains signs of tumour lysis syndrome?

A

AKI (raised creatinine)
Arrhythmia
Seizure

21
Q

What disease is indicated by Reed-Sternberg cells on blood film?

A

Hodgkin’s lymphoma

22
Q

What age group is commonly affected by Hodgkin’s lymphoma?

A

Bimodal - 30s and 70s

23
Q

What is the gold-standard investigation for Hodgkin’s lymphoma?

A

Lymph node biopsy

24
Q

A patient has lymphadenopathy that is more painful on consumption of alcohol.
What is the likely diagnosis?

A

Hodgkin’s lymphoma

25
Q

What 3 types of Hodgkin’s lymphoma may indicate a good prognosis?

A

Nodular sclerosing
Mixed cellularity
Lymphocyte-predominating (best prognosis)

26
Q

What 4 features of Hodgkin’s lymphoma indicate a poor prognosis?

A

Lymphocyte predominant subtype
>10% weight loss in 6 months
Nightsweats
Fever >38 C

27
Q

How are the features of lymphadenopathy seen in Hodgkin’s lymphoma?

A

Non-tender, painless, rubbery, asymmetrical.

28
Q

What is the management of Hodgkin’s lymphoma?

What should the patient be warned about the treatment?

A

Chemotherapy - infertility

Radiotherapy - risk of further cancer down the line

29
Q

What blood cancer are HIV, EBV and autoimmune conditions risk factors for?

A

Hodgkin’s lymphoma

30
Q

An individual has a normocytic anaemia, eosinophilia and raised LDH.
What is the likely diagnosis?

A

Hodgkin’s lymphma

31
Q

What is the staging system for Hodgkin’s lymphoma?

How does it work?

A 
Ann-Arbour:
I - 1 node
II - 2(+) nodes on 1 side of diaphragm
III - nodes on both sides of diaphragm
IV - disease beyond lymph nodes

subtypes:
A - no systemic symptoms other than pruritis
B - systemic symptoms (fever, weight loss, night sweats)

Eg. Stage IIIB

32
Q

What are disease are EBV, malaria and HIV risk factors for?

A

Burkitt lympoma

33
Q

What are disease is H. pylori infection a risk factor for?

A

MALT lymphoma

34
Q

What are the subtypes of non-Hogkin’s lympoma?

A

Burkitt
MALT
Diffuse, B-cell lymphoma

35
Q

What is the management of non-Hodgkin’s lymphoma?

A 
Watchful waiting
Chemo
Rituximab
Radiotherapy
Stem cell transplant
36
Q

What is myeloma?

A

Cancer of plasma cells that secrete a single type (monoclonal) antibody.

37
Q

What is monoclonal gammopathy of undetermined significance (MGUS)?

A

Myeloma with no symptoms

Incidental finding

38
Q

What is smouldering myeloma?

A

A progression of monoclonal gammopathy of undetermined significance
But still considered pre-malignant

39
Q

What is Waldenstrom’s macroglobulinemia?

A

A subtype of smouldering myeloma that secretes IgM

40
Q

What result is seen on FBC in myeloma?

A

Marrow failure:
Anaemia
Neutropaenia
Thrombocytopaenia

41
Q

How can the features of myeloma be remembered with the pneumonic CRAB?

A

calcium high
renal failure
anaemia (normocytic, normochromic)
Bone pain/lesions

42
Q

What investigations are there for myeloma?

Consider imaging also.

A 
BLIP:
urinary Bence jones protein
serum free Light chains
serum Immunoglobulin
serum protein electrophoresis

Whole body MRI, CT, x-ray skeletal survey:
raindrop skull
bone lesions

43
Q

What is the management for myeloma?

A

Chemo + Boretezomid, Thalidomide, Dexamethasone

Stem cell transplant

VTE prophylaxis

Bone disease:

  • Bisphosphonates
  • Radiotherapy
  • Surgical stabilisation
44
Q

What disease demonstrates Rouleaux formation on blood film?

A

Myeloma

Haematology (4 decks)

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