Luke 2 Flashcards
What is the function of blood?
- transportation
- regulation
- protection
What are the components of blood?
- blood plasma
- formed elements (RBC, WBC, platelets)
What is Leukaemia?
- neoplastic proliferation of immature white blood cells
What are the three types of WBC?
- monocytes
- lymphocytes (t-cell responsible for cell mediated immunity, b-cel associated with antibody production)
- granulocytes
What are the three types of haematological malignancies?
- leukaemia
- mutliple myeloma
- Polycythaemia Rubra Vera
What does leukaemia do to bone marrow?
- take up space in the marrow so there is no room left for normal cells to grow
What are the four types of leukaemia?
- ALL (acute lymphoblastic leukaemia)
- AML (acute myeloid leukaemia)
- CLL (chronic lymphocytic leukaemia)
- CML (chronic myeloid leukaemia)
How many cases of Leukaemia are diagnosed in australia each year?
- 4800 cases
- 40% of which are acute
What age groups does ALL affect?
- most common in children
- rare in adults
What are groups does AML affect?
- mainly affects adults
- can occur in children and adolescents
What age groups does CLL affect?
- affects adults
- does not occur in children
What age does CML affect?
- occur at any age
- but uncommon below 20
What is ALL?
- bone marrow makes too many large immature lymphocytes (lymphocytes are not able to fight infection)
- can cause infection, anaemia and easy bleeding
- gets worse quickly
Where does ALL spread to?
- central nervous system
What is the epidemiology of ALL?
- male: female = 1:1
- affects children: 40% occur between 2-5yrs
What is the aetiology of ALL?
- down’s syndrome
- environmental agents (viruses)
- radiation exposure
- benzene
- anti-cancer treatment (after Hodgkins diease and ovarian treatment)
- smoking
What are the signs and symptoms of ALL?
- peripheral lymphadenopathy
- splenomegaly
- liver palpable
- bone marrow failure
- bruising/bleeding due to thrombocyopenia
- petechiae
- fever
- shortness of breath
- loss of appetite or weight loss
What are the clinical features of ALL in child?
- anaemia
- thrombocyopenia
- infection
- bone pain
- malaise
- oral and pharyngeal ulceration
What are the adverse prognostic features in child ALL?
- Adverse cytogenetic markers
- CNS disease at presentation
- Early marrow relapse
- Testicular relapse
- T-cell phenotype
- Philadelphia chromosome present
What is the staging for ALL?
- not formal staging
- total WCC more then 20,000 poorer prognosis
- age
- metastases to brain or spinal cors
- Philadelphia chromosome
- cancer recurrence
What is the prognosis for ALL?
- child = 70%
- adult = 35%
What characterises AML?
- overproduction of immature WBC (myeloblasts)
- dividing cells fill up bone marrow preventing it from making healthy blood
What is the epidemiology of AML?
- rare (0.8% of tumours)
- 2000 adults, 50 children per year
- men slighly higher
- common age is 60
- rare under 20
What is the aetiology of AML?
- damage to one of more genes that control blood development
- ionising radiation
- blood disorder (myelodysplastic syndrome)
- downs syndrome
What are the signs and symptoms of AML?
- anaemia
- low platelet count (bruising)
- low WCC (persistent infection)
- feeling unwell or run donw
- aching joints and bones
- unusual bleeding (reduced platelets)
- weight loss
- bone pain
What is the AML staging?
- french-american-british (FAB) classification system
What is the AML prognosis?
- 40% of all patients cured
- 50% by successful transplantation
- poor prognosis if WCC > 100 x 10
What characterised CML?
- excess granulocytes
- progress slowly in chronic phase (4-6 yrs) then rapid (3-9 months)
- only cure is stem cell transplant
What is the epidemiology of CML?
- 249 per year diagnosed
- age over 50
- slightly higher in males
What is the aetiology of CML?
- not really known
- 90% have philadelphia chromosome
- ionising radiation
What are the signs are symptoms are CML?
- Massive splenomegaly
- Tiredness & pale skin due to anaemia
- bleeding or bruising
- Petechiae
- Women may find their periods become very much heavier
- Generalised itching
- Hepatomegaly (abdominal distension)
- Lymphadenopathy
- Thrombocytopenia (due to bone marrow failure)
- Bone pain
- Fevers
- Weight loss
- Very high white cell count
What are the three phases of CML?
- chronic phase (stable)
- accelerated phase
- blast phase
What are the three stages of CML?
- relapsed chronic myeloid leukaemia
- complete remission (blood and bone marrow are normal)
- molecular remission (not more philadelphia chromosome)
What characterises CLL?
- similar to non hodgkins lymphoma
- results from acquired injury to DNA of single cell in bone marrow
- leukaemic cells dont impede blood production as much as ALL
What is the epidemiology of CLL?
- 718/year diagnosed
- age over 60
- more in men
- uncommon under 40
What is the aetiology of CLL?
- no known factors
- damaged to one or more genes that control cell development
- family history
What are the signs and symptoms or CLL?
- Peripheral lymphadenopathy
- Splenomegaly
- Hepatomegaly
- Anaemia
- Tiredness
- Shortness of breath
- Recurrent infections of skin, lungs, kidneys & other areas
- Fever
- Sweats
- Weight loss
What is hairy cell leukaemia?
- overproduction of B lymphocyte (WBC)
- abnormal WBC build up in spleen causing splenomegaly
What is the aetiology of hairy cell leukaemia?
- 100 cases/year
- age 40-60
- men: women = 5:1
- develops slowly
- cause unknown
What are the signs and symptoms of hairy cell leukaemia?
- Tiredness, Weakness, lethargy
- Weight loss
- Infections
- Breathlessness
- Anaemia
- Frequent infections
- Enlarged spleen (abdominal discomfort)
What characterises mutliple myeloma?
- cancer of the plasma cell
- continued synthesis and release of immunoglobulins
- Neoplastic proliferation of a clone of B-lymphocytes results in large numbers of immature plasma cells that infiltrate the bone marrow
What is the epidemiology of multiple myeloma?
- uncommon under 50
- males: females = 2:1
- twice as frequent in African Americans as in white
- first degree relative
- BRCA 1 and 2
What is the aetiology of multiple myeloma?
- radiation exposure
What are the signs and symptoms of mutliple myeloma?
- acute back pain
- weakness/fatigue
- anorexia
- reccurent bacterial infections
- bone lesions tenderness
- anaemia
- hypercalcaemia
What is the clinical management of multiple myeloma?
- not curable but can relieve symptoms
- chemo (oral melphalan)
- palliative RT
What characterises Polycythaemia Rubra Vera?
- uncommon bone marrow disease
- proliferation of RBC (myeloproliferation) is not regulated by erythropoietin
What is the aetiology of Polycythaemia Rubra Vera?
- age 50-65
What are the clinical features of Polycythaemia Rubra Vera?
- Increased peripheral cell volume
- Headaches/ Dizziness
- Tinnitus (rinning in your ears)
- Tiredness
- Visual disturbances
- Cyanosis (blue around the lips)
- Pruritus on exposure to heat/cold
- Palpable spleen (75%)
- Hepatomegaly (30%)
- Haemorrhage
- Venous thrombo-embolism
