Myeloproliferative Neoplasms (MPN) Flashcards

1
Q

what is MPN?

A

disorder of clonal HSCs with increased production of one or more types of haemopoietic cells
maturation is relatively preserved

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2
Q

classification of MPN

A
  1. BCR-ABL1 negative

2. BCR-ABL1 positive

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3
Q

what is encompassed in BCR-ABL1 negative?

A

polycythaemia vera
essential thrombocythaemia
primary myelofibrosis

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4
Q

what is encompassed in BCR-ABL positive?

A

CML

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5
Q

what is CML?

A

chronic myeloid leukaemia= increased granulocytes due to philadelphia chromosome)

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6
Q

define chronic myeloid leukaemia?

A

proliferation of myeloid cells (granulocytes, monocytes, platelets and RBCs)

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7
Q

phases in CML

A

chronic phase

blast crisis

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8
Q

presentation of CML

A

splenomegaly
hypermetabolic symptoms= gout
hyperleukocytosis and priapism

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9
Q

diagnosis of CML

A

FBC
hypercellular bone marrow
philadelphia chromosome

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10
Q

what does the FBC in CML show?

A

leucocytosis with neutrophilia and myeloid precursors, eosinophilia, basophilia

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11
Q

what is the philadelphia chromosome?

A

chromosome 9 and chromosome 22 trade parts

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12
Q

what does the philadelphia chromosome cause in CML?

A

chromosome 22 now contains BCR-ABL1 gene which causes phosphorylation

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13
Q

how to distinguish reactive changes

A

only neutrophil count raised
plasma viscosity
CRP

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14
Q

management of CML

A

tyrosine kinase inhibitors e.g. imatinib

blast crisis is fatal so may need transplant

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15
Q

features common to BCR-ABL1 negative

A
>65
often asymptomatic
increased cellular turnover
splenomegaly
marrow failure
thrombosis
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16
Q

increased cell turnover

A

gout
fatigue
weight loss
sweats

17
Q

what is polycythaemia vera (PV)?

A

erythrocytosis causing high Hb and Hct

18
Q

what does PV need to be distinguished from?

A
  • secondary polycythaemia

- pseudo-polycythaemia

19
Q

causes of secondary polycythaemia

A

chronic hypoxia (COPD)
smoking
EPO-secreting tumour

20
Q

causes of pseudo-polycythaemia

A

dehydration
diuretics
obesity (reduced plasma, normal red cell mass)

21
Q

presentation of PV

A

features common to MPN
headache, fatigue, blood viscosity raised
itch (aquagenic pruritis- itchy after a hot bath)

22
Q

diagnosis of PV

A

splenomegaly
JAK2 mutation
investigations for other causes

23
Q

what is the JAK2 mutation?

A

mutated kinase with loss of auto-inhibition causing activation of erythropoiesis

24
Q

investigations for other causes of polycythaemia

A

CXR
O2 saturation
DH
EPO levels

25
Q

management of PV

A

mainly to stop thrombus formation:

  • venesect to Hct <0.45
  • aspirin
  • cytotoxic oral chemotherapy e.g. hydroxycarbamide
26
Q

what is essential thrombocythaemia?

A

uncontrolled production of abnormal platelets

27
Q

what does essential thrombocythaemia cause?

A

thrombosis

acquired VWD

28
Q

why does ET cause acquired VWD?

A

platelets absorb VWF

29
Q

presentation of ET

A

vaso-occlusive complications e.g. black toe

bleeding

30
Q

diagnosis of ET

A

FBC

genetics= JAK2, CALR, MPL, some are triple negative

31
Q

management of ET

A

antiplatelets e.g. aspirin

cytoreductive therapy to control proliferation e.g. hydroxycarbamide, anagrelide, IFN-alpha

32
Q

what is myelofibrosis?

A

bone marrow fibrosis and extramedullary haematopoiesis

33
Q

presentation of MF

A

marrow failure (anaemia, infection, bleeding)
splenomegaly (LUQ pain, portal hypertension)
hypercatabolic

34
Q

diagnosis of MF

A

blood film
dry aspirate or fibrosis on trephine biopsy
JAK2, CALR, MPL or triple negative

35
Q

what does the blood film show in MF?

A

leucoerythroblastic + teardrop RBCs

36
Q

other causes of leucoerythroblastic blood film

A

sepsis

marrow infiltration

37
Q

management of MF

A

blood transfusion, platelet transfusions, antibiotics
allogenic stem cell transplant in some
splenectomy
JAK2 inhibitors

38
Q

why are more measures taken in MF?

A

more aggressive