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Third year haematology lectures > Leukaemias and lymphomas > Flashcards

Leukaemias and lymphomas Flashcards

1
Q

front

A

back

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2
Q

Name 4 differentials for purpura in a 48 year old year old male with a 4 day Hx of fatigue and breathlessness.

A

Thrombocytopenia (low platelets)VasculitisDrugs e.g. steroidsSenile purpura (age related)

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3
Q

Give two examples of causes of thrombocytopenia with examples for each.

A

Peripheral consumption

Autoimmune destruction (Immune Thrombocytopenia Purpura)
Splenic pooling
infection
active thrombosis

Reduced production

  • Drug induced bone marrow suppression
  • primary marrow failure (rare)
  • Marrow infiltration (primary or secondary)
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4
Q

{{2 1 0.png}}

A

{{2 0 0.png}}

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5
Q

Define acute leukaemia.

A

A rapid clonal haematopoietic stem cell disorder resulting in accumulation of immature precursors in the bone marrow.

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6
Q

What are the urgent investigations in newly diagnosed acute leukaemia?

A

Coagulation screen (due to risk of life threatening DIC)Blood group and antibody screen.Biochemistry:

  • Renal function
  • Liver function
  • Calcium, phosphate, magnesium, CRP
  • Uric acid

Microbiology

  • Blood and urine cultures
    Radiology- CXR

ECG and echo

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7
Q

How does acute leukaemia present?

A

Marrow failure

  • anaemia: fatigue, SOB, headaches, palpitations
  • leucopenia: infections, mouth ulcers
  • thrombocytopenia: purpura, bleeding, bruising

Hyperviscosity due to leucocytosis

  • headaches, SOB
  • Visual blurring with venous engorgement and retinal haemorrhages
  • confusion

Leukaemic infiltration

  • Swollen gums
  • skin lesions chloromax
  • hepatosplenomegaly
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8
Q

What are the two broad classifications of acute leukaemia?

A

acute myeloid leukaemia and acute lymphoblastic leuakemia

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9
Q

{{7 1 0.png}}What is this cell, what does it contain, what is it diagnostic of?

A

A blastan auer rodAML

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10
Q

What role does immunophenotyping play in diagnosing leukaemia?

A

A flow cytometer can determine what molecules a cell is expressing on its surface and it its cytoplasm. It can therefore distinguish between myeloid and lymphoid blasts

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11
Q

What are the typical myeloid immunophenotype markers?

A

CD13, CD33, CD117, MPO

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12
Q

What are the typical lymphoid immunophenotype markers?

A

CD10, CD19, CD79a, TdT

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13
Q

What are the causes of acute leukaemia?

A

Previous chemotherapy/toxins

alkylating agents (long latency)
Topoisomerase II inhibitors: short latency
Benzene exposure

Radiation exposure
Inherited predisposition

  • Down syndrome and acute megakaryoblastic leukaemia
    Other haematological disorders
  • Myelodysplasia
  • Myeloproliferative conditions

There is often no identifiable cause.

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14
Q

What is the overall cure rate for AML in the 18-60 age group?

A

40%

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15
Q

what is the life expectancy without treatment?

A

weeks- months

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16
Q

What are some important prognostic factors?

A

Age (older associated with worse outcomes)Presenting white count (worse with higher counts)Response to chemotherapyCytogenetics at presentation

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17
Q

Which is a certain chromosomal translocation associated with a good risk in AML?

A

8;21

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18
Q

What is the treatment regime for AML?

A

4 courses of IV chemotherapy (2 induction and 2 consolidation)5-10 days of IV chemotherapy2-3 weeks of neutropenia: often complicated by neutropenic sepsisMarrow recoveryTotal duration 4-6 weeksIf poor risk cytogenetics, consider bone marrow transplant as course 3 or 4

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19
Q

What are the typical side effects of treatment for AML?

A

Bone marrow suppression

  • Anaemia
  • neutropenia
  • thrombocytopenia

tumour lysis syndrome

  • arrythmias
  • renal failure

hair loss

Nausea/vomiting
Profound fatigue
Chemotherapy induced tissue damage: heart, lungs, brain, GI mucosa
Increased risk of secondary malignancy
Death (during induction 10%)
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20
Q

What supportive care is usually used alongside treatment for AML?

A

Blood and platelet transfusionsAntibiotics and antifungalsAntiemeticsNutritionPsychological support

21
Q

What sort of venous access is usually required for treatment?

A

A hickman line which goes directly to the right side of the heart.

22
Q

What is the maximum age at which chemotherapy for AML should be considered?

A

70

23
Q

What percentage of patients with non-related bone marrow transplants die?

A

15-20%

24
Q

{{22 1 0.png}}Spot diagnosis

A

Childhood ALL

25
Q

How does childhood ALL present?

A

Marrow failure

  • Anaemia
  • Infections
  • Purpura/bleeding

Bony pains

  • Off legs
  • Limping

Non-specifically unwell

26
Q

What are the positive and negative immunophenotypes for ALL?

A

PositiveCD10, CD19, CD79a, TdTNegativeMPO, CD15, CD33

27
Q

What does it mean to be hyperdiploidic?Associated with positive or negative prognosis? Why?

A

Greater than 50 chromosomes.Confers good prognosis, possibly due to an increased sensitivity to chemotherapeutic agents

28
Q

What are the poor prognostic indicators for childhood ALL?

A

High white cell count at presentationInfant or adolescentSpecific cytogenetic abnormalitiesSlow responses to chemotherapyHigh ‘minimal residual disease’ levels at end of induction

29
Q

What is the overall cure rate for childhood ALL?

A

70-80%

30
Q

Is adulthood ALL more or less common than AML? Does it have a better or worse prognosis?

A

Adult ALL is much less common than AML and has a worse prognosis

31
Q

What are the stages of ALL treatment?

A

Induction (steroids and a vinca alkaloid)Consolidation/intensificationCNS prophylaxisMaintenanceTotal lengthTwo years for girls and three years for boys

32
Q

What is the commonest form of childhood cancer?

A

ALL

33
Q

40 year old man presents to GP with 8 week history of neck lumps. 6 weeks of drenching night sweats.
OE there is cervical lymphadenopathy

  • largest node measures 3cm
    Spot diagnosis?
A

Lymphoma: malignancy of the lymphatic system

34
Q

How does hodgkins lymphoma present?

A

Cervical lymphadenopathyLarge anterior mediastinal massLeft hilar lymphadenopathyleft pleural effusion

35
Q

{{33 0 0.png}}What is the name of this cell?What is the nickname for this cell?What does this cell indicate?

A

Reed-Sternberg cellOwls eyesHodgkin lymphoma

36
Q

How is Hodgkin’s lymphoma treatment different between loclaised disease and advanced disease?

A

Localised diseaseShort course of chemotherapy (2-4 cycles) + local radiotherapy90% chance of cureAdvanced disease6 cycles of chemotherapy80% chance of cure

37
Q

What is ABVD in relation to lymphoma?

A

Tretament protocol consisting of:doxorubicinbleomycinvinblastinecarbazine

38
Q

A 64 year old woman discovers enlarged lymph nodes in both axillae and sees her GP, She is otherwise well.OE, modest cervical and axillary lymphadenopathy and splenomegalyShe is referred to the surgeons for lymph node biopsy.Spot diagnosis

A

Diffuse large B-cell NH lymphoma

39
Q

What are the immunophenotype indicators for large B cell NH lymphoma?

A

CD19 and CD20Ki67= indicator of cell growth

40
Q

What are the treatment principles for low grade lymphoma?

A

Not curable for vast majority of patientsIndications for treatment include: fevers/sweats/weight loss, large lymph nodes, organ compression, bone marrow failure.Treatment does not increase survival.

41
Q

What is the median survival for patients with low grade lymphoma with or without treatment?

A

10-12 years

42
Q

What is the most common type of adult NHL? How common is it?

A

Diffuse large B-cell NHL (high grade B-NHL)>30%

43
Q

What is the median age for diffuse large B-cell NHL?

A

55-65 years

44
Q

What is the treatment of high grade B cell NHL?

A

Intensity chemotherapy with curative intentR-CHOP

  • 70-80% chance of cure
  • outpatient chemo, 6 cycles
  • Rituximab= anti-cd20 monoclonal antibody
45
Q

{{43 1 0.png}}Spot diagnosis

A

Chronic lymphatic leukaemia

46
Q

What is bone marrow trephine test?

A

A bone marrow trephine means that they remove a 1 or 2cm core of bone marrow in one piece.

The bone marrow trephineshows the structure of the bone marrow inside the bone, whereas the aspiration takes just the bone marrow cells.

47
Q

What is the treatment for CLL?

A

Treatment indications as for low grade lymphomaFludarabine/cyclophosphamide/rituximab (FCR)Not curative

48
Q

What is the median survival for CLL?

A

10 years

Third year haematology lectures (11 decks)

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