Leukemia Flashcards
What is Leukaemia?
Cancer of a particular line of stem cells in the bone marrow causing unregulated production of different types of blood cells.
In what two ways can Leukaemia be categorised?
By the rate of progression of the disease i.e acute or chronic or by the type of cell effected i.e either myeloid or lymphoid
What are the four different types of Leukaemia?
- Chronic myeloid leukaemia
- Chronic lymphocytic leukaemia
- Acute myeloid leukaemia
- Acute lymphoblastic leukaemia
What is the brief pathophysiology of leukaemia?
Genetic mutations lead to increased production of a single type of WBC. This can lead to suppression of the other cell lines and underproduction of the other cell types.
At what stages of life do each type of leukaemia occur?
- ALL - child under 5 years and over 45’s
- CLL - over 55’s
- CML - over 65’s
- AML - over 75’s
How does leukaemia present?
Fairly non specific symptoms
- Fatigue
- Fever
- Pallor (anaemia)
- Petechiae and abnormal bruising - due to the low platelets
- Swollen lymph nodes
- Abnormal bleeding
- Hepatospenomegaly
What is the initial investigation when leukaemia is suspected?
FBC
What blood test can be raised in Leukaemia but is not necessarily specific to leukaemia?
Lactate dehydrogenase
What can be done for a definitive diagnosis of leukaemia?
Bone marrow biopsy
What is ALL?
Malignant change in the lymphocyte precursor cells - which causes acute proliferation usually a b lymphocytes. They replace other cells in the bone marrow which results in a pancytopenia
Which leukaemia is most commonly associated with downs syndrome?
ALL
What investigations would you do to diagnose ALL?
Blood film - would show blast cells
Genetic testing - t15,17 translocation and the philadelphia chromosome
What is CLL?
Chronic proliferation of a single type of well defined lymphocyte usually B lymphocytes
How does CLL present?
It is often asymptomatic but it can prevent with infections, anaemia, bleeding and weight loss. It can also cause haemolytic anaemia
What can CLL transform into?
High grade lymphoma called righters transformation
What will the blood film show in CLL?
Smearing of the cells which occurs as the B cells rupture when the blood film is being prepared.
What are the three phases of chronic myeloid leukaemia?
- Chronic phase - 5 year asymptomatic phase
- Accelerator phase
- Blast phase
What happens in the accelerator phase of CML?
Abnormal blast cells take up a high proportion of the cells in the bone marrow and blood (10-20%). Patients become more symptomatic and develop anaemia, thrombocytopenia and become immunocompromised.
What happens in the blast phase of CML?
Involves an even high proportion of blast cells and blood (>30%). This phase has severe symptoms and pancytopenia. It is often fatal.
What genetic mutation is specific to CML?
Translocation of t(9,22) - the philadelphia chromosome
What is AML?
The most common type of leukaemia in adult.
There are many different types of acute myeloid leukaemia all with slightly different cytogenetic differences and differences in presentation.
What would you see on the blood film in AML?
High proportion of blast cells. These blast cells can have rods inside their cytoplasm that are named auer rods.
How is Leukaemia managed?
It is primarily treated with chemotherapy and steroids
Can do radiotherapy, bone marrow transplant and surgery.
What is tumour lysis syndrome?
It is a result of the release of uric acid from the cells that are being destroyed by chemotherapy. This uric acid can form crystals, when these form in the kidneys this can cause and acute kidney injury.
How can we treat tutor lysis syndrome
Use allopurinol for the uric acid
