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3MB Haematology > Leukaemias > Flashcards

Leukaemias Flashcards

1
Q

What is acute myeloid leukaemia?

A

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

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2
Q

What is acute lymphoblastic leukaemia?

A

Rapidly progressing cancer of the lymphoid cell line

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3
Q

What is Chronic myeloid leukaemia?

A

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

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4
Q

What is Chronic lymphocytic leukaemia?

A

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

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5
Q

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

A

Children under five years

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6
Q

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

A

ALL

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7
Q

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

A

CLL

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8
Q

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

A

CML

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9
Q

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

A

AML

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10
Q

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

A

A single type of abnormal white blood cell

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11
Q

What causes pancytopenia?

A

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

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12
Q

One key presenting feature of leukaemia is..

A

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

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13
Q

What is Petechiae?

A

Less than 3 and caused by burst capillaries

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14
Q

What is Purpura?

A

3 – 10mm

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15
Q

What is Ecchymosis?

A

Larger than 1cm

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16
Q

Ix for suspected leukaemia

A

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

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17
Q

Bone marrow biopsy is usually taken from the..

A

Iliac crest

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18
Q

Bone marrow aspiration vs trephine

A

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

Trephine: Taking a solid core sample of the bone marrow

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19
Q

ALL involves proliferation of which cell?

A

B-lymphocyte precursor cell

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20
Q

ALL leads to..

A

Pancytopenia

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21
Q

Which type of leukaemias are associated with Philadelphia chromosome?

A

CML
Sometimes ALLA

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22
Q

Which type of cells are affected in CLL?

A

Well differentiated B-lymphocytes

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23
Q

Which type of leukaemia can cause warm autoimmune haemolytic anaemia?

A

CLL

24
Q

Smear or smudge cells are ruptured white blood cells

A

CLL

25
Q

What is the chronic phase of ALL?

A

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

26
Q

What is the accelerated phase of ALL?

A

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

27
Q

What is the blast phase of CLL?

A

Higher proportion of blast cells in the blood

Severe symptoms, pancytopenia and is often fatal

28
Q

What is Philadelphia chromosome?

A

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

29
Q

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

A

AML

30
Q

High proportion of blast cells
Auer rods

A

AML

31
Q

Examples of targeted therapies (mainly used in CLL)

A

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

32
Q

What characterises Tumour Lysis syndrome?

A

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

33
Q

Mx of Tumour lysis syndrome

A

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

34
Q

Lethargy and pallor in ALL indicates..

A

Anaemia

35
Q

Frequent or severe infections in ALL indicates..

A

Neutropaenia

36
Q

Easy bruising/petechiae in ALL indicates..

A

Thrombocytopenia

37
Q

What are the different types of ALL?

A

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

38
Q

What are the poor prognostic factors of ALL?

A

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

39
Q

Anaemia in ALL may occur due to..

A

Bone marrow replacement or autoimmune hemolytic anaemia (AIHA)

40
Q

Thrombocytopenia in ALL may occur due to..

A

Bone marrow replacement or immune thrombocytopenia (ITP)

41
Q

What does the image show?

A

Smudge B cells - CLL

42
Q

Common complications of CLL

A

Anaemia
Hypogammaglobulinaemia
Warm autoimmune haemolytic anaemia
Richter’s transformation

43
Q

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

A

Richter’s transformation

44
Q

Classification of AML

A

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

45
Q

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

A

CML

46
Q

Mx of CML

A

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

47
Q
A
48
Q

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

A

Coagulation defect - DIC in acute promyelocytic leukaemia
Gum infiltration

49
Q

What does the image show?

A

Auer rod - acute myeloid leukaemia

50
Q

________ is required to differentiate between ALL and AML

A

Immunophenotyping

51
Q

Which genetic techniques are used in acute leukaemia

A

Karotyping
NGS or WGS

52
Q

Problems of marrow suppression is acute leukamia

A

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

53
Q

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

A

Fungal infections

54
Q

Complications of anti-leukaemic treatment

A

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)

55
Q

Late effects complications of anti-leukaemic treatment..

A

Loss of fertility
Cardiomyopathy with anthracyclines

56
Q

People with CLL can develop infections such as..

A

Community acquired pneumonia

57
Q

People with CLL can develop..

A

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

Autoimmune thrombocytopenia (ITP)

3MB Haematology (23 decks)

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