Leukaemias

Question 1

How does CML present?

Answer 1

• no bruising
• many neutrophils, few promyelocytes

Question 2

How does CML present?

Answer 2

• no bruising
• many neutrophils, few promyelocytes

Question 3

How does AML present?

Answer 3

• bruising
• many promyelocytes, few neutrophils

Question 4

What is the difference between the four leukaemias?

Answer 4

CML - neutrophils (later stages)
AML - neutrophils (early)
CLL - lymphocytes (late)
ALL - lymphocytes (early)

Question 5

What tests are used in the diagnosis of leukaemias?

Answer 5

• FBC (pancytopenia, neutropenia etc)
• peripheral blood smear
• bone marrow biopsy

Question 6

How is CLL managed?

Answer 6

Observation

Question 7

How is CML managed?

Answer 7

Imatinib (TKI)

Question 8

How is AML managed?

Answer 8

Aggressive chemotherapy

Question 9

How is ALL managed?

Answer 9

Allogeneic stem cell transplantation

Question 10

Which chromosomal mutation is associated with CML?

Answer 10

Philadelphia chromosome (9:22 translocation - BCR-ABL)

Question 11

How is CML diagnosed?

Answer 11

• bone marrow biopsy (high myeloid:erythroid ratio)
• FISH karyotype analysis (Philadelphia)

Question 12

What are the symptoms of CML?

Answer 12

• fatigue (anaemia)
• abdominal fullness/early satiety (splenomegaly)
• frequent infections/bleeding (WBC & platelet dysfunction)

Question 13

What are the 3 phases of CML?

Answer 13

Chronic (asymptomatic)
Accelerated (proliferation)
Blast/crisis ( becomes AML/ALL)

Question 14

What is the leukaemoid reaction?

Answer 14

Normal overreaction of bone marrow to infection/stressors
- WCC >40k
- left shift

Question 15

What are the myeloid:erythroid ratios of each CML stage?

Answer 15

Acute <10%
Accelerated 10-20%
Blast phase >20%