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what are the 3 white blood cell lines?
- neutrophils
- lymphocytes
- monocytes
what is the age distribution of Hodgkin’s lymphoma?
Bi modal; 2 peaks;
- 20 years
- 75 years
risk factors for Hodgkins lymphoma
- HIV
- EBV
- autoimmune; RF & sarcoidosis
- family history
what does EBV cause
glandular fever
features of lymphadenopathy in non hogkins lymphoma?
- rubbery
- non tender
how does the lymphadenopathy sometimes change in sensation?
can become painful when individual drinks alcohol
name B symptoms
- fever
- weight loss
- night sweats
staging for Lymphoma
Ann Arbor
outline the 4 Ann Arbor stages
1) Confined to single lymph node region
2) involvement of 2 or more nodal areas on the same side of the diaphragm
3) involvement of nodes on both sides of the diaphragm
4) Spread beyond lymph nodes e.g. liver or bone marrow
Ann arbor stage 1?
Confined to single lymph node region
Anna arbor stage 2?
involvement of 2 or more nodal areas on same side of diaphragm
Ann arbor stage 3?
Involvement of nodes on both sides of the diaphragm
Ann Arbor stage 4?
Widespread involvement including non-lymphatic organs such as the lungs or liver
diagnostic test - hodgkins lymphoma
lymph node excision biopsy
describe Reed-Sternberg cells
abnormally large B cells, have multiple nuclei with nucleoli inside
3 types of Non hodgkins lymphoma
Burkitt lymphoma
MALT lymphoma
Diffuse large B cell lymphoma
starry sky appearance under microscopy
Burkitts lymphoma
components of lymphoma MDT
- haematologist
- specialist nurse
- clinical oncologist
- radiologist
- specialist histopathologist
differential diagnoses for cervical lymphandenopathy
- disseminated malignancies
- TB
- lymphoma
- sarcoid
- glandular fever
lymph of the head, neck, face, meningeal lymphatic vessels drain into…
deep cervical lymph nodes
symptoms of ALL
- anaemia (low Hb)
- infection (low WCC)
- bleeding (low platelets)
malignancy of lymphoid cells, affecting B or T cell lines. promoting uncontrolled proliferation of immature blast cells with marrow failure & tissue infiltration
ccute lymphoblastic leukaemia
neoplastic proliferation of blast cells derived from myeloid elements
acute myeloid leukaemia
peripheral blood film of the acute form of leukaemia
dominated by immature cells or blast cells and classifird into; acute myeloblasts or lymphoblasts leukaemia.
peripheral blood film of the chronic form of leukaemia
dominated by more mature cells .e.g neutrophils/lymphocytes
which leukaemia most commonly affects under 5 year olds
acute lymphoblastic leukaemia
which leukaemia commonly affects over 75 year olds
acute myeloid leukaemia
what is petechiae?
tiny spots of blood under the skin that do not blanch
why is purpura/petechiae a common presentation for leukaemia?
due to low platelet count, patient more likely to bleed
differentials for non blanching rash (6)
- leukaemia
- meningococcal septicaemia
- vasculitis
- HSP
- ITP
- NAI
timeframe for FBC when suspeciting leukaemia
FBC within 48 hours when suspect leukaemia
definitive diagnosis of leukaemia achieved how?
bone marrow biopsy
which leukaemia is associated with down’s syndrome?
Acute lymphoblastic leukaemia
blood film in ALL
blast cells
ALL associated with what translocation?
Philadelphia chromosome (9:22)
what is Richter’s transformation
CLL transforming into high-grade lymphoma
blood film shows ‘smear’ or ‘smudge’ cells
Chronic LL:
Occur during the process of preparing the blood film where aged or fragile white blood cells rupture and leave a smudge on the film
which leukaemia has 3 phases & what are they?
CML
chronic, accelerated, blast phase
what happens in the accelerated phase of CML?
the abnormal blast cells take up a high proportion of cells in the bone marrow and blood - patient become symptomatic developing anaemia, thrombocytopenia & become immunocompromised
most common leukaemia in adults
AML
blood film in AML
high proportion of blast cells. the blast cells can have rods in side their cytopasm that are named Auer rods
characteristic of blast cells seen on blood film in AML
blast cells can have rods called Auer rods (in their cytoplasm)
leukaemia most commonly associated with Philadelphia translocation (9:22)
CML
which leukaemia has a 5 year asymptomatic phase
CML
management of leukaemia (6)
- Oncology MDT
- Chemotherapy
- Steroids
- Radiotherapy
- Bone marrow transplant
- Surgery
what is tumour lysis syndrome a complication of?
chemotherapy
what is tumour lysis syndrome caused by?
release of uric acid from cells that are being destroyed by chemotherapy
name 8 complications of chemotherapy
- infertility
- tumour lysis syndrome
- secondary malignancy
- neurotoxicity
- cardiotoxicity
- failure
- stunted growth in children
- infections due to immunodeficiency
what can uric acid from tumour lysis syndrome become?
urate crystals & lodge in kidneys
medications used to reduce high amounts of uric acid in tumour lysis syndrome (2)
- allopurinol
- rasburicase
3 tings release in tumour lysis syndrome
- uric acid
- potassium
- phosphate
