Leukaemias Flashcards
What is acute myeloid leukaemia?
Rapidly progressing cancer of the myeloid cell line - proliferation with blocked differentiation/ maturation
What is acute lymphoblastic leukaemia?
Rapidly progressing cancer of the lymphoid cell line
What is Chronic myeloid leukaemia?
Clonal stem disorder of the myeloid cell line - proliferation with preserved maturation
What is Chronic lymphocytic leukaemia?
Clonal (malignant) lymphoproliferative disorder of the mature B lymphoid compartment
Most types of leukaemia occur in patients over 60-70. The exception is acute lymphoblastic leukaemia, which most commonly affects..
Children under five years
_______ is the most common leukaemia in children and is associated with Down syndrome
ALL
______ is associated with warm haemolytic anaemia, Richter’s transformation and smudge cells
CLL
_____ has three phases, including a long chronic phase, and is associated with the Philadelphia chromosome
CML
_____ may result in a transformation from a myeloproliferative disorder and is associated with Auer rods
AML
A genetic mutation in one of the precursor cells in the bone marrow leads to excessive production of..
A single type of abnormal white blood cell
What causes pancytopenia?
The excessive production of a single type of cell can suppress the other cell lines, causing the underproduction of different cell types
One key presenting feature of leukaemia is..
Bleeding under the skin due to thrombocytopenia - causes non-blanching lesions
What is Petechiae?
Less than 3 and caused by burst capillaries
What is Purpura?
3 – 10mm
What is Ecchymosis?
Larger than 1cm
Ix for suspected leukaemia
FBC
Blood film
LDH
Bone marrow biopsy
CT/PET
Lymph node biopsy
Lymph node biopsy and immunophenotyping
Bone marrow biopsy is usually taken from the..
Iliac crest
Bone marrow aspiration vs trephine
Aspiration: Taking a liquid sample of cells from within the bone marrow
Trephine: Taking a solid core sample of the bone marrow
ALL involves proliferation of which cell?
B-lymphocyte precursor cell
ALL leads to..
Pancytopenia
Which type of leukaemias are associated with Philadelphia chromosome?
CML
Sometimes ALLA
Which type of cells are affected in CLL?
Well differentiated B-lymphocytes
Which type of leukaemia can cause warm autoimmune haemolytic anaemia?
CLL
Smear or smudge cells are ruptured white blood cells
CLL
What is the chronic phase of ALL?
Asymptomatic, and patients are diagnosed after an incidental finding of a raised white cell count
What is the accelerated phase of ALL?
When the abnormal blast cells take up a high proportion of the bone marrow and blood cells
Patients are symptomatic and develop anaemia, thrombocytopenia and immunodeficiency
What is the blast phase of CLL?
Higher proportion of blast cells in the blood
Severe symptoms, pancytopenia and is often fatal
What is Philadelphia chromosome?
Abnormal chromosome 22 caused by a reciprocal translocation of genetic material between a section of chromosome 9 and 22. This creates BCR-ABL1, which codes for an abnormal tyrosine kinase enzyme that drives the proliferation of the abnormal cells
_____ can be the result of a transformation from a myeloproliferative disorder, such as polycythaemia ruby vera or myelofibrosis
AML
High proportion of blast cells
Auer rods
AML
Examples of targeted therapies (mainly used in CLL)
Tyrosine kinase inhibitors (e.g., ibrutinib)
Monoclonal antibodies (e.g., rituximab, which targets B-cells)
What characterises Tumour Lysis syndrome?
High uric acid
High potassium (hyperkalaemia)
High phosphate
Low calcium (as a result of high phosphate)
Mx of Tumour lysis syndrome
Very good hydration and urine output
Allopurinol or rasburicase may be used to suppress the uric acid levels
Lethargy and pallor in ALL indicates..
Anaemia
Frequent or severe infections in ALL indicates..
Neutropaenia
Easy bruising/petechiae in ALL indicates..
Thrombocytopenia
What are the different types of ALL?
Common ALL (75%), CD10 present, pre-B phenotype
T-cell ALL (20%)
B-cell ALL (5%)
What are the poor prognostic factors of ALL?
Age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
Non-Caucasian
Male sex
Anaemia in ALL may occur due to..
Bone marrow replacement or autoimmune hemolytic anaemia (AIHA)
Thrombocytopenia in ALL may occur due to..
Bone marrow replacement or immune thrombocytopenia (ITP)
What does the image show?
Smudge B cells - CLL
Common complications of CLL
Anaemia
Hypogammaglobulinaemia
Warm autoimmune haemolytic anaemia
Richter’s transformation
CLL +:
Lymph node swelling
Fever without infection
Weight loss
Night sweats
Nausea
Abdominal pain
Richter’s transformation
Classification of AML
MO - undifferentiated
M1 - without maturation
M2 - with granulocytic maturation
M3 - acute promyelocytic
M4 - granulocytic and monocytic maturation
M5 - monocytic
M6 - erythroleukaemia
M7 - megakaryoblastic
An increase in granulocytes at different stages of maturation +/- thrombocytosis
Decreased ALP
Splenomegaly/abdo discomfort
CML
Mx of CML
Imatinib - inhibitor of the tyrosine kinase
Hydroxyurea
Interferon-alpha
Allogenic bone marrow transplant
Subgroups of AML may have characteristic presentation. This can be..
Coagulation defect - DIC in acute promyelocytic leukaemia
Gum infiltration
What does the image show?
Auer rod - acute myeloid leukaemia
________ is required to differentiate between ALL and AML
Immunophenotyping
Which genetic techniques are used in acute leukaemia
Karotyping
NGS or WGS
Problems of marrow suppression is acute leukamia
Anaemia
Neutropenia - gram negatives can cause sepeis
Thrombocytopenia - bleeding (purpura/petechiae)
Bacterial infections are common, but prolonged neutropenia makes patients susceptible to..
Fungal infections
Complications of anti-leukaemic treatment
Bacterial: broad spectrum antibiotics as soon as
neutropenic fever
Fungal if prolonged neutropenia and persisting fever
unresponsive to anti-bacterial agents
PJP (more relevant in ALL therapy)
Late effects complications of anti-leukaemic treatment..
Loss of fertility
Cardiomyopathy with anthracyclines
People with CLL can develop infections such as..
Community acquired pneumonia
People with CLL can develop..
Autoimmune haemolysis [Direct antibody (Coomb’s) test positive]
Autoimmune thrombocytopenia (ITP)
