Types of leukaemia

Question 0

Classification of acute leukaemia based on..

Answer 0

Morphology
Cytochemistry 
Immunophenotype (flow cytometry)
Genetic abnormalities (karyotype,FISH,PCR)

Question 1

Define acute leukaemia

Answer 1

Presence of at least 20% blasts in the PB or BM

Question 2

What is most common malignancy in children

Answer 2

ALL

Question 3

Most common secondary leukaemia

Answer 3

AML

Question 4

Morphology in AML

Answer 4

Large blasts
Primitive nuclei
Granules
Auer rods

Question 5

AML cytochemistry

Answer 5

Sudan black B pos

MPO pos

Question 6

AML flow cytometry

Answer 6

CD13

CD33

Question 7

Cytogenetics of AML

Answer 7

t(8:21)
t(15:17)
inv(16)

Question 8

Morphology ALL

Answer 8

Scanty cytoplasm
Primitive nuclei
No granules
No auer rods

Question 9

Cytochemistry of ALL

Answer 9

Sudan black neg

MPO neg

Question 10

Flow cytometry ALL

Answer 10

B - CD10, CD 19

T - CD7, CD3

Question 11

Cytogenetics ALL

Answer 11

t(4:11)

t(12:21)

Question 12

Markers for immature cells

Answer 12

CD34

HLA-DR

Question 13

Myeloid marker

Answer 13

CD13

Question 14

T cell marker

Answer 14

CD 2

Question 15

B cell markers

Answer 15

CD 19, CD 10

Question 16

How to prevent infections

Answer 16

Single room (reverse isolation)
Regular hand washing
Avoid contact with any sick person
No fresh fruit or raw veg
Antibiotics and anti fungal prophylaxis
Careful oral care
Care of IV lines

Question 17

Translocations of Burkitt’s

Answer 17

t(8:14)
t(2:8)
t(8:22)

8=myc oncogene
14,2,22 = immunoglobulin chain

Question 18

Types of Burkitt’s

Answer 18

Endemic - jaw mass
Sporadic - abdo mass, ascites
Immunodeficiency associated - advanced

Question 19

Egs of chronic myeloproliferative disorders

Answer 19

CML
Polycythemia Vera
Essential Thrombocytopenia
Primary myelofibrosis

Question 20

Cytogenetic finding in CML

Answer 20

t(9:22) Philadelphia chr

9 - BCR/ABL. 22 - light chain

Question 21

What does increase BCR/ABL cause

Answer 21

Increase tyrosine kinase activity
Increased cell proliferation
Decreased apoptosis
Adherence of BM cells to stroma

Question 22

Course of CML

Answer 22

1. Initial chronic stable phase
2. Accelerated phase
3. Blast phase

Question 23

Rx of CML

Answer 23

Tyrosine kinase inhibitors (not cure)
BM transplant (cure)

Question 24

Underlying pathology on BCR/ABL neg

Answer 24

JAX2 mutation = unregulated proliferation of granulocytes, megakaryocytes and erythrocytes

Question 25

Causes of increased RBC other than PV

Answer 25

1ry familial polycythemia Ectopic EPO production Chronic tissue hypoxia Relative - dehydration, burns

Question 26

Lab findings in PV

Answer 26

Increase: RBC, Hb, hematocrit, platelet, blood viscosity Abnormal megs - hypersegmented nuclei

Question 27

Rx of PV

Answer 27

Repeated venesection Long term warfarin Aspirin Cytoreductive agents

Question 28

Course of PV

Answer 28

Prodromal, prepolycythemic phase Overt polycythemic phase Spent/ postpolycythemic phase

Question 29

Reactive causes of thrombocytosis

Answer 29

1. Infection/inflammation 2. Chronic haemorrhage 3. Fe def 4. Post surgery 5. Malignancy

Question 30

Why can ET present with bleeding despite increased platelets

Answer 30

Platelets are mostly non functional

Question 31

Rx of ET

Answer 31

Control platelet count Cytoreductive agents Aspirin

Question 32

Define primary myelofibrosis

Answer 32

Progressive generalized reactive fibrosis of BM with haemopoiesis in liver and spleen. BM fibrosis due to megakaryocytes proliferation -> PDGF.

Question 33

Course of primary myelofibrosis

Answer 33

Prefibrotic phase | Fibrotic phase

Question 34

Rx of primary myelofibrosis

Answer 34

Palliative Reduce anaemia HSM In kids BM transplant may cure

Question 35

Chronic B cell leukaemic types

Answer 35

CLL Hairy cell leukaemia B prolymphocytic leukaemia

Question 36

Chronic T cell leukaemic types

Answer 36

T prolymphocytic leukaemia Large granular lymphocytic leukaemia Adult T leukaemia/Lymphoma

Question 37

Presentation of hairy cell leukaemia

Answer 37

Severe infection Anaemia Splenomegaly

Question 38

Clinical picture with multiple myeloma

Answer 38

BM infiltration - bone pain, fractures, amaemia, infection, bleeding, osteolytic lesions -> renal calcification Monoclonal proteins - renal failure (high calcium, urea, light chains) hyperviscosity, peripheral neuropathy, amyloidosis, high ESR

Question 39

Diagnosis of multiple myeloma

Answer 39

``` Monoclonal Ig Immunotyping Hence Jones proteins in urine Many plasma cells in aspirate (X-ray, ESR) NB exclude other causes of monoclonal Ig ```

Question 40

Define amyloidosis

Answer 40

Deposition of protein extracellularly that disrupts tissue/organ function.

Question 41

Organs affected by systemic amyloidosis that generally show clinically

Answer 41

Heart - failure Nerves - neuropathy, carpal tunnel Kidneys - failure Tongue - macroglossia