Malignant blood disorders

Question 1

Polycythaemia presentation

note is a myeloproliferative neoplasm

Answer 1

Huge spleen, elevated haemoglobin, elevated haematocrit
associated elevated platelets?

differential with compromised respiratory failure and increased epo, renal carcinoma?

Question 2

Lymphomas

Answer 2

Hodgkins, younger adults

Non-Hodgkins all ages

Question 3

Myelomas/Multiple myeloma

Answer 3

Cancers of plasma cells

Replace bone marrow and release cytokines that increase bone lysis (lesions in bone on radiography?)

Question 4

Leukaemias are?

Answer 4

Proliferation of HSC’s/ immature bone marrow cells. Failure of differentiation, proliferate and replace regular marrow, spills into peripheral blood.
Myeloid or lymphoid stem cells usually

Question 5

Acute leukaemia subtypes

Answer 5

AML-acute myeloid (predominantly adults 85%)

ALL- acute lymphoblastic (predominantly children 85%)

Question 6

Causes/ pathogenesis of leukaemia

Answer 6

Congenital risk factor
Viral infections (HTLV1)
Radiation
Chemical/Damaging drugs

Most cases can not identify why

Question 7

Reminder of CML and drug to treat

Answer 7

t(9;22) some ALL too but in all CML

imatinib

Question 8

Signs and symptoms of acute leukaemia. Cause of these?

Answer 8

Cause: bone marrow failure

Anaemia: Dyspnoea, fatigue, chest pain (low Hb)
Neutropenia: infection, wounds slow to heal
Thrombocytopenia: easy bruising and bleeding (wet petechiae?)
Other: Bone marrow-bone pain, enlarged liver, spleen, nodes,

Question 9

Leukaemia diagnosis

Answer 9

blood count: low Hb, increased white cells (blasts), low neutrophils and platelets.

Bone marrow biopsy, >20% blasts

Specialised testing: immunophentoyping, chromosome, molecular studies

Question 10

Acute leukamia therapy

Answer 10

Induction therapy, consoidation and maintenance

Bone marrow transplants (autologous (own) allogeneic)