Unit 2 Case 3: ALL Flashcards
two lineages of white blood cell development
myelocytic and lymphocyticq
myelocytic
begins with myeloblast
forms neutrophils, eosinophils, basophils
monocytes
lymphocytic
forms lymphocytes
T and B cells
2 phases of leukaemia classification
speed of progression
type of white blood cell affected
acute leukaemia
abnormal blood cells that are immature
unable to function normally
rapidly multiply
aggressive treatment
chronic leukaemia
too many cells or not enough cells
more mature blood cells
replicate slow and function normally for a period of time
lymphocytic leukaemia
affects lymphocytes
that form lymphoid or lymphatic tissue
myelogenous leukaemia
affects myeloid cells
which produce red and white blood cells and platelet producing cells
4 main types of leukaemia
acute lymphocytic
acute myelogenous
chronic lymphocytic
chronic myelogenous
most common type of leukaemia in children
ALL
most common leukaemia in adults
CLL
what are the different types of anaemia
aplastic
iron deficiency
sickle cell
thalessemia (leads to anaemia)
vitamin deficiency
aplastic anaemia
when body stops producing enough new blood cells
leaves you fatigued and more prone to infections and uncontrolled bleeding
rare and serious
treated with medication, blood transfusion or stem cell transplant
iron deficiency anaemia
where the blood lacks enough healthy red blood cells
insufficient iron
not enough haemoglobin
treated via iron supplementation
sickle cell anaemia
red blood cells are shaped like sickle or crescent moons
become rigid and sticky
slow or block blood flow
thalassemia
inherited blood disorder
causes your body to make less haemoglobin than usual
can cause anaemia
vitamin deficiency anemia
pernicious anaemia
lowered amounts of B-12 and folate
without B-12 body produces red blood cells that are too large and don’t correctly carry oxygen
symptoms for aplastic anaemia
fatigue
shortness of breath
rapid or irregular heart rate
pale skin
nosebleed
iron deficiency anaemia symptoms
fatigue
wekaness
pale skin
chest pain
fast heatbeat
light headed
cold hands and feet
brittle nails
sickle cell anaemia symptoms
episodes of pain
swelling of hands and feet
frequent infections
delayed puberty
vision problems
thalessemia symptoms
fatigue
weakness
pale or yellow skin
facial bone deformities
slow growth
vitamin deficiency anemia symptoms
fatigue
shortness of breath
dizziness
weight loss
numbness in hands and feet
what are iron supplements
used to treat iron deficiency anaemia
body uses iron to make haemoglobin
low level of iron is a haemoglobin count less than or equal to 130/120 in males/females
anatomy of the lymph node
covered in unit 3
risk factors of ALL
radiation exposure
certain chemical exposures e.g. benzene
certain viral infections e.g. HTLV-1
certain genetic syndormes
age
race
ethnicity
gender
identical twin with ALL
symptoms of ALL
pale skin
tired and breathless
high temperature
night sweats
bone and joint pain
easily bruised skin
purple skin rash
repeated infections over short time
unusual and frequent bleeding
swollen lymph nodes
what are the two types of chromosomal translocation
reciprocal, balanced or unbalanced
robertsonian
reciprocal
no change in the amount of genetic information
part of one chromosome joins the other
occurs in both chromosomes
either balanced sections
or unbalanced sections
robertsonian
two chromosomes stick together
results in 35 chromosomes rather than 36
most common translocation in ALL
t(4:11)
most common translocation in pediatric ALL
12;21 (p13;q22)
chromosomal tests examples
PCR
FISH
cytogenetics
immunophenotyping
PCR
sensitive DNA test
look at individual gene changes and not the whole chromosome
used after treatment to check for remaining leukaemia cells
FISH
detects translocation changes
cytogenetics
observes dividing cells
philadelphia chromsome
translocation resulting in shortened chromosome 22
most common change
bone marrow aspirate
as ALL originates in the white blood cell producing in the bone marrow
allows bone marrow cells to be viewed
process of a full blood count
tourniquet is put around your arm, clench your fist
injection site is wiped down with an alcohol wipe
insertion of a needle into your arm and the blood is drawn up, collected inside a syringe or vial
gauze or cotton wool is pressed against the injection site
normal results of a full blood count
should have highest number of platelets
then RBCs
then neutrophils are the most common white blood cell
then lymphocytes, monocytes, eosinophils,basophils
abnormal blood count results
full blood count results are compared to charts which have the normal range and ratios for each type of blood cell
how does a FBC help to monitor chemotherapy
some cancers produce biomarkers found in the blood
during chemo they will increase showing that chemo is killing the cancer and is successful
process of a blood smear
take a small drop of blood
onto a microscope slide
use another slide as a spreader
align at 30-45 degree angle
bring drop up
and push downwards
what is a relapse in ALL
can come back after successful treatment
can have symptoms similar to when first diagnosed such as: chills, easy bleeding, unexplained weight loss and fatigue
risk for relapse
initial treatment may not have removed all cancer cells
cancer may have developed resistance to initial treatment
cancer may have metastasised
age
treatment for ALL relapse
can be treated with chemo
more intensive than the initial treatment
if at risk to not responding stem cell transplant could be offered immunotherapy for specific types
examples of immunotherapy drugs
blinatumomab
inotuzumab
imatinib
what are all of the phases of treatment of chemotherapy
induction
consolidation
interim maintenance
delayed intensification
maintenance
aim of induction
5 weeks long
remove as many leukaemia cells as possible in the blood and the bone marrow
prolonged hospital stay
white cell bound before starting
what are the drugs used in induction therapy
dexamethasone
vincristine
asparaginase
dexamethasone
glucocorticoid
28 days then tapered over 7 days
side effects: increased appetite, weight gain, nightmares, fluid retention, hyperglycaemia
vincristine
vinka alkaloid
once weekly for 5 weeks
disrupts microtubule skeleton
side effects: peripheral neuropathy
asparaginase
enzyme
depletes asparaginase
given in week 1 and 3
side effects: skin reactions, hypersensitivity, blood clotting disorders, raised LFTs, pancreatitis
aim of maintenance therapy
12 weeks
for 2 years in girls and 3 in boys
get rid of the few remaining leukaemia cells
MRD levels
neutrophil count required for maintenance therapy to go ahead
greater than 0.75 x 10^9 per litre
platelet count required for maintenance therapy to go ahead
greater than 75 x 10^9 per litre
what are the drugs used in maintenance therapy
mercaptopurine
methotrexate
mercaptopurine
purine antagonist
inhibit purine synthesis which interferes with DNA, RNA and protein synthesis
TMPT, thiopurine methyltransferase
side effects: thrombocytopenia, hepatotoxicity, myelosuppression
methotrexate
antimetabolite
dihydrofolate reductase inhibitor, folate antagonist
given once weekly
side effects: mucositis
what stresses do parents/families face with illnesses in family/kids
- illness-related factors, severity of child illness and type of health problem
- demographic factors, parent age, gender, socioeconomic status, ethnicity
3.psychological factors, current parent mental health, trait anxiety, family functioning, family structure
what stresses do parents/families have to face will illness in family/kids
difficult to relax
financial worries
difficult to remain positive
siblings display behaviour problems
having to remain strong
support for leukaemia patients and their families
Leukaemia CARE
to ensure everyone gets best possible diagnosis, information, advice, treatment and support
other charities to support leukaemia
blood cancer UK
leukaemia cancer society
B Positive
impacts of leukaemia on mental health
increased risk of anxiety and depression
-social isolation
-reliant on others for support
-worry about relapse
-infertility
-appearance
educational impacts of leukaemia
disruption to academic progress
treatments that suppress immune system leave you susceptible to other diseases, may further decrease academic progress
mild cognitive impairment
positive impacts of leukaemia
personal growth and resilience
motivation
improved relationships with those close to them
iron deficiency anaemia blood test results
Hb may be normal early on but will worsen as anaemia worsens
early on RBC’s may be normocytic and normochromc but as it progresses RBC’s become microcytc and hypochromic
MCV decreased
MCHC decreased
increased variation in RBC size
iron deficiency anaemia blood film results
smaller and paler RBC’s
ansiocytosis
poikilocytosis
full blood count results for pernicious anaemia
low Hb
MCV higher
blood film results perncious anaemia
abnormally large and shaped RBC’s
sometimes occasional giant WBC’s
aplastic anaemia full blood count
Hb low
RBC and WBC low
platelet count low
MCV normal or slightly raised
differential white blood count shows decrease in most types of cells but not lymphocytes
