Leukemia

Question 1

How do you know you’re dealing with
acute myelogenous leukaemia
and
acute lymphoblastic leukemia

Answer 1

Myeloperoxidase marker @ AML - Auer Rod

TdT + nuclear staining @ ALL

Question 2

Response to chemo for B – ALL?

Prognosis?

Markers?

Who gets T – ALL

Answer 2

Good response – give chemo to scrotum + CSF due to blood ball+brain barrier

Prognosis – on cytogenic abnormality
Translocation (12:21) = good, (9:22) = poor

T-ALL: CD 2-8
B-ALL: CD 10,19,20

T – ALL: TTTeens + TTThymic mass

Question 3

What is leukaemia

As the number of blasts increase how does the patient present?

Answer 3

Neoplastic proliferation of blasts – >
accumulation of > 20% blasts @ BM

Increased blasts crowd out normal haematopoiesis – >anaemia thrombocytopenia neutropenia

Question 4

Who does AML happen in?

3 main acute myeloid leukemias

Answer 4

Old ppl 55yrs

Promyelocytic, monocytic, megakaryoblastic

Question 5

Explain acute promyelocytic leukemia

Treat

Answer 5

15:17 translocation ->
retinoic acid receptor disrupted =block maturation ->
Promyelocytes accumulate ->
Auer rod activate coag casc = DIC

ATRA - all trans retinoic acid bind to altered receptor
-> blasts mature cells into neutrophils

Question 6

special feature of acute monocytic leukemia?

Acute megakaryoblast leukemia feature?

Answer 6

Proliferation of monoblasts -> infiltrate gums

Assoc with DOWNS

Question 7

What causes acute myeloid leukemia

Answer 7

Alkylating agents eg radiotherapy/chem ->

Pre-existing dysplasia -> AML ->

Hypercell BM - but cells not formed properly
Cells don’t get to the blood =
CYTOPENIAS - infection/bleeding

Question 8

What are myeloproliferative disorders?

What is an accumulation of myeloid blasts?
What is an accumulation of lymphoid blasts?
What is an accumulation of B+T cells?
What is an accumulation of RBC, baso, eosino, megakaryocyte?

Answer 8

Neoplastic prolif of mature cells of myeloid lineage

AML - accumulation of myeloid blast
ALL - accumulation of lymphoid blasts
Chronic Leukemia - accumulation of B+T cells
Myeloproliferative disorders - RBC, baso, eosino, megakaryocyte?

Question 9

In terms of labs what Duou know about myeloproliferative disorders?

3 main issues/features?

Answer 9

Cells of all lineage ⬆️⬆️
But classify it according to which myeloid cell is made more

1. High cell turnover -> hyperuricemia + gout
2. Burnout BM - fibrosis
3. Mutation @ stem cell -> arrest cell @ blast ️phase -> acute leukemia

Question 10

What is polycythemia Vera?

Mutation?

Answer 10

Neoplastic proliferation of mature myeloid cells especially RBC’s
Granulocytes + platelets up too

JAK kinase mutation -> PCV -> 
symptoms of HYPERviscosity 
- headache 
- blurred vision 
- flushed face cos of blood congestion
- ⬆️venous thrombosis @ portal/hep vein

Question 11

Treatment of PCV?

️patient presents with ⬇️SaO2 + ⬆️EPO
️patient presents with normal SaO2 + ⬆️️EPO
️patient presents with normal SaO2 + ⬇️️EPO

Answer 11

Phlebotomy + hydroxy-️️urea

Lung disease - reactive polycythemia

Renal cell carcinoma - ectopic EPO

Polycythemia Vera -
⬇️️EPO cos of neg feedback due to ⬆️RBC’s

Question 12

What diseases are assoc with DOWNS?

Answer 12

ALL > 5 years

Type of AML- Acute MegaKaryoBlastic Leukemia