leukaemias acute and chronic

Question 1

leukaemia

Answer 1

A malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. These suppress the production of normal blood cells, leading to anaemia and other symptoms

Question 2

reason for symptoms in acute leukaemia

Answer 2

bone marrow failure - leukaemia expansion has wiped out the normal bone marrow

Question 3

reason for symptoms in chronic leukaemia

Answer 3

the accumulation of the leukaemic cells

Question 4

Myodsplastic syndrome

Answer 4

Clonal blood disorder characterised by failure of effective haemopoiesis. have dysplastic bone marrow cell appearance in at least one lineage.
about a quarter will progress to AML.
Incurable unless SCT is done - can only do in those fit enough

Question 5

Myloproliferative disorders

Answer 5

clonal blood disorder characterised by effective haemopoiesis.
o Too many platelets (Essential Thrombocythaemia)
o Too many red cells (+plts +WC) – Polycythaemia Vera or Primary Polycythaemia (same thing!)
o Too much fibrous tissue (+platelets +WC)(Myelofibrosis) – due to excessive amounts of megakaryocytes

Question 6

who is more likely to develop ALL?

Answer 6

the young

Question 7

who is more likely to develop AML?

Answer 7

the elderly

Question 8

in which leukaemia are you most likely to develop a purpuric rash?

Answer 8

ALL

Question 9

what would an FBC in CLL show?

Answer 9

lymphocytosis

Question 10

what two major mutations would you do cytogenetics for in CLL

Answer 10

woulf perform FISH looking for trisomy of chromosome 12 as well as looking for 17p deletions - p53 which is involved in normal cell apoptosis.

Question 11

what immune complications may you have in CLL?

Answer 11

AI haemolytic anaemia, auto-immune thrombocytopenia

Question 12

which CLL patients are treated?

Answer 12

those who are symptomatic e.g. sweats, weight loss, symptomatic nodes
Bone marrow failure

Question 13

how is CLL treated

Answer 13

imatinib

Question 14

describe a presentation of acute leukaemia

Answer 14

• Rapid onset of symptoms
• Lethargy
• Infection
• Bleeding and bruising
• Bone pain – particularly present in children
• Gum swelling
• Lymphadenopathy, skin rash

Question 15

give two risk factors for the development of ALL

Answer 15

o Ionising radiation during pregnancy and down’s syndrome are important associations

Question 16

give the signs and symptoms of ALL

Answer 16

o Marrow failure
o Infiltration
 Hepato, splenomegaly, lymphadenopathy, orchidomegaly, CNS involvement e.g. cranial nerve involvement or meningism

Question 17

which investigations would you order in ALL

Answer 17

o Characteristic blast cells on blood film and bone marrow
o WCC is usually high
o CXR and CT scan – look for mediastinal and abdominal lymphadenopathy
o LP to look for CNS involvement

Question 18

describe some signs of AML

Answer 18

o Infiltration
 Hepatomegaly, splenomegaly, gum hypertrophy, skin involvement,
 CNS can become infiltrated but this is rare at presentation

Question 19

describe the lymphadenopathy in CLL

Answer 19

 Enlarged, rubbery, non-tender lymph nodes