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Haematology > Leukaemias > Flashcards

Leukaemias Flashcards

1
Q

Leukaemia divides into 4 main types depending on cell involvement

A

Lymphoid or myeloid
Acute or Chronic

Acute lymphoblastic (ALL)
Chronic Lymphocytic (CLL)
Acute myeloid (AML)
Chronic Myeloid (CML)
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2
Q

ALL

A

malignancy of B or T (lymphoid) cells.
Maturation ceases and uncontrolled proliferation of immature Blast cells occurs with BM failure and tissue infiltration.

Genetic susceptibility + environmental Trigger.

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3
Q

ALL is commonest…

A

in children

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4
Q

Presentation of ALL

A

BM failure - Anaemia (low Hb), Infection (low WCC), and bleeding (low Platelets)

Infiltration: HSM, Lymphadenopathy, Orchidomegaly, CNS involvement - palsies/meningisms , Bone pain

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5
Q

Ix of ALL

A

Bone Marrow - >20% blasts present (this is the important one)

Bloods - *Increase WCC: Lymphblasts; Decreased RBC, Platelets and PMN

CXR - mediastinal and abdominal LN

LP for CNS involvement

*Blood levels of WC may be raised BUT sometimes the blasts will stay in the the BM and so present with normal WCC

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6
Q

Management of ALL

A

Supportive: Blood and Platelet transfusion, IV fluids, Allopurinol to prevent TLS (quick Turn over of cells causes increased uric acid release and so allopurinol Protects Kidneys)

Infections - IV antibiotic - Gent + Tazocin
Prophylaxis may use ciprofloxacin

Chemo
Induction (dexamethasone)
Consolidation
Maintenance

BMT - best solution in younger pts

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7
Q

AML

A

Neoplastic, Rapid Proliferation of Cells within the myeloid lineage

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8
Q

AML is commonest…

A

Leukaemia in adults

incidence increases with age

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9
Q

Presentation of AML

A

BM Failure and (If APML - AML wiht release of thromboplastin) DIC - use all-transretinoic acid with Chemo to reduce risk

Infiltration
HSM, Gum hypertrophy, Skin involvement and CNS:

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10
Q

Dx

A

WCC may be High, Lw or normal and so it depends on BM Biopsy

Bx shows Auer Rods and >20% blasts

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11
Q

Management of AML

A

Supportive: Blood and platelet transfusion, IV fluids, allopurinol (as with ALL)

Infections: IV antibiotics - Gent + Tazocin
Prophylaxis - Cirpofloxacin

Chemo:
Very intense with neutropaenia plus decrease platelets
ATRA or APML

BMT

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12
Q

Complications of Both ALL and AML

A

Infection is a big danger - be aware of sepsis

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13
Q

CLL

A

Mature B cells have escaped apoptosis and undergo proliferation

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14
Q

CLL is the commonest…

A

Leukaemia in the western world

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15
Q

Presentation of CLL

A

Often Asymptomatic = incidental finding
may be anaemic or infection prone
If severe: B-symptoms

Enlarged, rubbery, non-tender nodes
HSM

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16
Q

Ix of CLL

A

(marked) lymphocytosis
Smear cells on peripheral Smear
Decreased Ig and +DAT
Rai or Binet Staging

Binet A = < 3 LN sites (no anaemia or thrombocytopaenia)

Binet B = > 3 LN siites (no anaemia or thrombocytopaenia)

Binet C = > 3 LN sites W/anaemia and thrombocytopaenia

17
Q

Natural Hx of CLL

A

Some remain static for years and may even regress.
Sow Growth with death often being attributed to infection secondary to disease (commonly pneumococcu, haemophilus, meningococcus, aspergiloosis) or transformation of the leukaemia to large B-cell lymphoma (Richter’s transformation)

18
Q

Treatment of CLL

A

Indications for treatment are:
symptoms
Un-mutated Ig - bad prognosis
17pDeletions - bad prognosis

Supportive care
Chemo: Cyclophosphamide, rituximab

Raditherapy may relive the LN and splenomegaly

19
Q

CML

A

Uncontrolled proliferation of myeloid cells

it is therefore a myeloproliferative disorder

20
Q

CML is commonest…

A

in 40 - 60 year olds

21
Q

Features of CML

A 
Systemic B-symptoms 
MASSIVE HSM + abdo discomfort
Platelet dysfunction - bruising/bleeding
Gout
Hyperviscocity (masses of cells is blood)
22
Q

Explain the Philadelphia Chromosome

A

Translocation: t(9:22)
creates BCR-ABL fusion gene - tyrosine kinase activity
Present in >80% CML

23
Q

Ix of CML

A

increased WCC - Basophils and PMN
increased Urate
BM cytogenesis = Ph +ve`

24
Q

Treatment

A

Very specific to CML

Imatinib - BCR-ABL TK inhibitor

Stem cell transplant (allogenic ) from HLA-matched donor offers only cure.

Haematology (11 decks)

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