Leukemia

Question 1

Leukaemia presentation

Answer 1

Weight loss
Night sweats
Fever
Lymphadenopathy
Hepatosplenomegaly
Tiredness / lethargy - SOB - pallor - anaemia
Easy bleeding / bruising - thrombocytopenia
Serious or frequent infection

Question 2

Ix for suspected leukaemia

Answer 2

FBC
U+Es, LFTs, LDH, urate
Bone marrow biopsy - definitive diagnosis
Virology - hep B,C, hiv, ebv

Question 3

Acute lymphoblastic leukaemia presentation (clinical signs and symptoms) - classic exam question

Answer 3

Young children
Weight loss, fever, night sweats
Bleeding, bruising (low platelets) anaemia
infections (low wbc)
PAIN IN JOINTS AND BONES
progression over days to weeks

Question 4

Acute lymphoblastic leukaemia investigations

Answer 4

FBCs - leucocytosis
Blood film - blast cells
Blast count
Immunophenotyping - whether T cell or b cell
LFTs , U+Es - burden

Question 5

What is ALL

Answer 5

Acute lymphoblastic leukaemia

Haematology malignancy - uncontrolled proliferation of immature lymphoid precursor cells in bone marrow causing bone marrow failure and presence of lymphoblasts in peripheral blood

Question 6

Subtypes of ALL

Answer 6

B cell - most common
T cell

Question 7

When do you send a child to A+E suspecting ALL

Answer 7

Petechiae or hepatosplenomegaly in children with one of these symptoms
- pallor
- persistent fatigue
- unexplained fever
- persistent or recurrent infection
- generalised lymphadenopathy
- unexplained bruising / bleeding

Question 8

ALL management

Answer 8

Chemotherapy
Steroids
CNS prophylaxis

Question 9

What is AML

Answer 9

Acute myeloid/myeloblastic
Uncontrolled proliferation of myeloid precursor in bone marrow leading to bone marrow failure and accumulation of blasts in peripheral blood

Question 10

Epidemiology of AML

Answer 10

Adults more often
Exposure to ionising radiation - prev cancer treatment or disaster

Question 11

Signs and symptoms of AML

Answer 11

Bone marrow failure - bleeding, anaemia, infections , bruising, pain in joints and bones
Signs of tissue infiltration- hepatomegaly, splenomegaly and gum hypertrophy

Fever
Unintentional weight loss
Night sweats

PROGRESSION OVER DAYS TO WEEKS

Question 12

AML investigations

Answer 12

Blood tests - may show increased white blood elbow cells (leucocytosis), U+Es and LFTs to assess tumour burden
Blood film - blasts
Bone marrow biopsy - blasts and Auer rods
Cytogenics
Immunophenotyping - distinguishes AML from ALL

Question 13

Complication of AML

Answer 13

Leukostasis / hyperleucocytosis - SEND STRAIGHT TO A+E IF WBC IS REALLY HIGH - call haematologist

Question 14

What is leukostasis / leucocytosis and its complications

Answer 14

Congested microvascular use with white cell plugs

Complications
- affects any organ but especially lungs causing SOB and hypoxia
- if affecting CNS - visual changes, dizziness, headaches, tinnitus/deafness, confusion
- priapism
- risk of inter cerebral haemorrhage (due to more clots from hypoxia)

Question 15

AML management

Answer 15

Chemotherapy
Bone marrow transplantation in otherwise fit healthy pts
Supportive management of infections

If leukostasis - cytoreduction with hydroxycarbamide

Question 16

Chronic myeloid leukaemia presentation

Answer 16

Older people
Philadelphia chromosome - translocation between 9 and 22

Fever, night sweats and unintentional weight loss
Anaemia, thrombocytopenia causes bleeding - bone marrow failure
Abdominal discomfort - SPLENOMEGALY

Leukostasis - visual disturbances, confusion, SOB, hypoxia, priapism , tinnitus / deafness

Question 17

Ix for CML

Answer 17

FBCs - cytopenia, leucocytosis (esp myeloid e.g. neutrophils, myelocytes, monocytes, basophils), blood film, anaemia
U+Es and LFTs for organ damage
Bone marrow biopsy - cytopgenics and blast count
BCR-ABL blood PCR
Philadelphia chromosome

Question 18

What are the stages of CML

Answer 18

Chronic phase - slow gradual progression with no blasts cells
Accelerated phase - some blast cells, persistent thrombocytopenia and chromosome abnormalities