Leukaemias

Question 1

What is acute myeloid leukaemia?

Answer 1

Rapidly progressing cancer of the myeloid cell line - proliferation with blocked differentiation/ maturation

Question 2

What is acute lymphoblastic leukaemia?

Answer 2

Rapidly progressing cancer of the lymphoid cell line

Question 3

What is Chronic myeloid leukaemia?

Answer 3

Clonal stem disorder of the myeloid cell line - proliferation with preserved maturation

Question 4

What is Chronic lymphocytic leukaemia?

Answer 4

Clonal (malignant) lymphoproliferative disorder of the mature B lymphoid compartment

Question 5

Most types of leukaemia occur in patients over 60-70. The exception is acute lymphoblastic leukaemia, which most commonly affects..

Answer 5

Children under five years

Question 6

_______ is the most common leukaemia in children and is associated with Down syndrome

Answer 6

ALL

Question 7

______ is associated with warm haemolytic anaemia, Richter’s transformation and smudge cells

Answer 7

CLL

Question 8

_____ has three phases, including a long chronic phase, and is associated with the Philadelphia chromosome

Answer 8

CML

Question 9

_____ may result in a transformation from a myeloproliferative disorder and is associated with Auer rods

Answer 9

AML

Question 10

A genetic mutation in one of the precursor cells in the bone marrow leads to excessive production of..

Answer 10

A single type of abnormal white blood cell

Question 11

What causes pancytopenia?

Answer 11

The excessive production of a single type of cell can suppress the other cell lines, causing the underproduction of different cell types

Question 12

One key presenting feature of leukaemia is..

Answer 12

Bleeding under the skin due to thrombocytopenia - causes non-blanching lesions

Question 13

What is Petechiae?

Answer 13

Less than 3 and caused by burst capillaries

Question 14

What is Purpura?

Answer 14

3 – 10mm

Question 15

What is Ecchymosis?

Answer 15

Larger than 1cm

Question 16

Ix for suspected leukaemia

Answer 16

FBC
Blood film
LDH
Bone marrow biopsy
CT/PET
Lymph node biopsy
Lymph node biopsy and immunophenotyping

Question 17

Bone marrow biopsy is usually taken from the..

Answer 17

Iliac crest

Question 18

Bone marrow aspiration vs trephine

Answer 18

Aspiration: Taking a liquid sample of cells from within the bone marrow

Trephine: Taking a solid core sample of the bone marrow

Question 19

ALL involves proliferation of which cell?

Answer 19

B-lymphocyte precursor cell

Question 20

ALL leads to..

Answer 20

Pancytopenia

Question 21

Which type of leukaemias are associated with Philadelphia chromosome?

Answer 21

CML
Sometimes ALLA

Question 22

Which type of cells are affected in CLL?

Answer 22

Well differentiated B-lymphocytes

Question 23

Which type of leukaemia can cause warm autoimmune haemolytic anaemia?

Answer 23

CLL

Question 24

Smear or smudge cells are ruptured white blood cells

Answer 24

CLL

Question 25

What is the chronic phase of ALL?

Answer 25

Asymptomatic, and patients are diagnosed after an incidental finding of a raised white cell count

Question 26

What is the accelerated phase of ALL?

Answer 26

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

Question 27

What is the blast phase of CLL?

Answer 27

Higher proportion of blast cells in the blood Severe symptoms, pancytopenia and is often fatal

Question 28

What is Philadelphia chromosome?

Answer 28

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

Question 29

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

Answer 29

AML

Question 30

High proportion of blast cells Auer rods

Answer 30

AML

Question 31

Examples of targeted therapies (mainly used in CLL)

Answer 31

Tyrosine kinase inhibitors (e.g., ibrutinib) Monoclonal antibodies (e.g., rituximab, which targets B-cells)

Question 32

What characterises Tumour Lysis syndrome?

Answer 32

High uric acid High potassium (hyperkalaemia) High phosphate Low calcium (as a result of high phosphate)

Question 33

Mx of Tumour lysis syndrome

Answer 33

Very good hydration and urine output Allopurinol or rasburicase may be used to suppress the uric acid levels

Question 34

Lethargy and pallor in ALL indicates..

Answer 34

Anaemia

Question 35

Frequent or severe infections in ALL indicates..

Answer 35

Neutropaenia

Question 36

Easy bruising/petechiae in ALL indicates..

Answer 36

Thrombocytopenia

Question 37

What are the different types of ALL?

Answer 37

Common ALL (75%), CD10 present, pre-B phenotype T-cell ALL (20%) B-cell ALL (5%)

Question 38

What are the poor prognostic factors of ALL?

Answer 38

Age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers Non-Caucasian Male sex

Question 39

Anaemia in ALL may occur due to..

Answer 39

Bone marrow replacement or autoimmune hemolytic anaemia (AIHA)

Question 40

Thrombocytopenia in ALL may occur due to..

Answer 40

Bone marrow replacement or immune thrombocytopenia (ITP)

Question 41

What does the image show?

Answer 41

Smudge B cells - CLL

Question 42

Common complications of CLL

Answer 42

Anaemia Hypogammaglobulinaemia Warm autoimmune haemolytic anaemia Richter's transformation

Question 43

CLL +: Lymph node swelling Fever without infection Weight loss Night sweats Nausea Abdominal pain

Answer 43

Richter's transformation

Question 44

Classification of AML

Answer 44

MO - undifferentiated M1 - without maturation M2 - with granulocytic maturation M3 - acute promyelocytic M4 - granulocytic and monocytic maturation M5 - monocytic M6 - erythroleukaemia M7 - megakaryoblastic

Question 45

An increase in granulocytes at different stages of maturation +/- thrombocytosis Decreased ALP Splenomegaly/abdo discomfort

Answer 45

CML

Question 46

Mx of CML

Answer 46

Imatinib - inhibitor of the tyrosine kinase Hydroxyurea Interferon-alpha Allogenic bone marrow transplant

Question 47

Answer 47

Question 48

Subgroups of AML may have characteristic presentation. This can be..

Answer 48

Coagulation defect - DIC in acute promyelocytic leukaemia Gum infiltration

Question 49

What does the image show?

Answer 49

Auer rod - acute myeloid leukaemia

Question 50

________ is required to differentiate between ALL and AML

Answer 50

Immunophenotyping

Question 51

Which genetic techniques are used in acute leukaemia

Answer 51

Karotyping NGS or WGS

Question 52

Problems of marrow suppression is acute leukamia

Answer 52

Anaemia Neutropenia - gram negatives can cause sepeis Thrombocytopenia - bleeding (purpura/petechiae)

Question 53

Bacterial infections are common, but prolonged neutropenia makes patients susceptible to..

Answer 53

Fungal infections

Question 54

Complications of anti-leukaemic treatment

Answer 54

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)

Question 55

Late effects complications of anti-leukaemic treatment..

Answer 55

Loss of fertility Cardiomyopathy with anthracyclines

Question 56

People with CLL can develop infections such as..

Answer 56

Community acquired pneumonia

Question 57

People with CLL can develop..

Answer 57

Autoimmune haemolysis [Direct antibody (Coomb’s) test positive] Autoimmune thrombocytopenia (ITP)