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Medicine: PBL wrap-ups > Unit 2 Case 3: ALL > Flashcards

Unit 2 Case 3: ALL Flashcards

1
Q

two lineages of white blood cell development

A

myelocytic and lymphocyticq

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2
Q

myelocytic

A

begins with myeloblast
forms neutrophils, eosinophils, basophils
monocytes

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3
Q

lymphocytic

A

forms lymphocytes
T and B cells

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4
Q

2 phases of leukaemia classification

A

speed of progression
type of white blood cell affected

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5
Q

acute leukaemia

A

abnormal blood cells that are immature
unable to function normally
rapidly multiply
aggressive treatment

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6
Q

chronic leukaemia

A

too many cells or not enough cells
more mature blood cells
replicate slow and function normally for a period of time

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7
Q

lymphocytic leukaemia

A

affects lymphocytes
that form lymphoid or lymphatic tissue

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8
Q

myelogenous leukaemia

A

affects myeloid cells
which produce red and white blood cells and platelet producing cells

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9
Q

4 main types of leukaemia

A

acute lymphocytic
acute myelogenous
chronic lymphocytic
chronic myelogenous

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10
Q

most common type of leukaemia in children

A

ALL

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11
Q

most common leukaemia in adults

A

CLL

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12
Q

what are the different types of anaemia

A

aplastic
iron deficiency
sickle cell
thalessemia (leads to anaemia)
vitamin deficiency

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13
Q

aplastic anaemia

A

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

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14
Q

iron deficiency anaemia

A

where the blood lacks enough healthy red blood cells
insufficient iron
not enough haemoglobin
treated via iron supplementation

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15
Q

sickle cell anaemia

A

red blood cells are shaped like sickle or crescent moons
become rigid and sticky
slow or block blood flow

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16
Q

thalassemia

A

inherited blood disorder
causes your body to make less haemoglobin than usual
can cause anaemia

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17
Q

vitamin deficiency anemia

A

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

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18
Q

symptoms for aplastic anaemia

A

fatigue
shortness of breath
rapid or irregular heart rate
pale skin
nosebleed

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19
Q

iron deficiency anaemia symptoms

A

fatigue
wekaness
pale skin
chest pain
fast heatbeat
light headed
cold hands and feet
brittle nails

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20
Q

sickle cell anaemia symptoms

A

episodes of pain
swelling of hands and feet
frequent infections
delayed puberty
vision problems

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21
Q

thalessemia symptoms

A

fatigue
weakness
pale or yellow skin
facial bone deformities
slow growth

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22
Q

vitamin deficiency anemia symptoms

A

fatigue
shortness of breath
dizziness
weight loss
numbness in hands and feet

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23
Q

what are iron supplements

A

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

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24
Q

anatomy of the lymph node

A

covered in unit 3

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25
Q

risk factors of ALL

A

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

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26
Q

symptoms of ALL

A

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

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27
Q

what are the two types of chromosomal translocation

A

reciprocal, balanced or unbalanced
robertsonian

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28
Q

reciprocal

A

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

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29
Q

robertsonian

A

two chromosomes stick together
results in 35 chromosomes rather than 36

30
Q

most common translocation in ALL

A

t(4:11)

31
Q

most common translocation in pediatric ALL

A

12;21 (p13;q22)

32
Q

chromosomal tests examples

A

PCR
FISH
cytogenetics
immunophenotyping

33
Q

PCR

A

sensitive DNA test
look at individual gene changes and not the whole chromosome
used after treatment to check for remaining leukaemia cells

34
Q

FISH

A

detects translocation changes

35
Q

cytogenetics

A

observes dividing cells

36
Q

philadelphia chromsome

A

translocation resulting in shortened chromosome 22
most common change

37
Q

bone marrow aspirate

A

as ALL originates in the white blood cell producing in the bone marrow
allows bone marrow cells to be viewed

38
Q

process of a full blood count

A

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

39
Q

normal results of a full blood count

A

should have highest number of platelets
then RBCs
then neutrophils are the most common white blood cell
then lymphocytes, monocytes, eosinophils,basophils

40
Q

abnormal blood count results

A

full blood count results are compared to charts which have the normal range and ratios for each type of blood cell

41
Q

how does a FBC help to monitor chemotherapy

A

some cancers produce biomarkers found in the blood
during chemo they will increase showing that chemo is killing the cancer and is successful

42
Q

process of a blood smear

A

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

43
Q

what is a relapse in ALL

A

can come back after successful treatment
can have symptoms similar to when first diagnosed such as: chills, easy bleeding, unexplained weight loss and fatigue

44
Q

risk for relapse

A

initial treatment may not have removed all cancer cells
cancer may have developed resistance to initial treatment
cancer may have metastasised
age

45
Q

treatment for ALL relapse

A

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

46
Q

examples of immunotherapy drugs

A

blinatumomab
inotuzumab
imatinib

47
Q

what are all of the phases of treatment of chemotherapy

A

induction
consolidation
interim maintenance
delayed intensification
maintenance

48
Q

aim of induction

A

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

49
Q

what are the drugs used in induction therapy

A

dexamethasone
vincristine
asparaginase

50
Q

dexamethasone

A

glucocorticoid
28 days then tapered over 7 days
side effects: increased appetite, weight gain, nightmares, fluid retention, hyperglycaemia

51
Q

vincristine

A

vinka alkaloid
once weekly for 5 weeks
disrupts microtubule skeleton
side effects: peripheral neuropathy

52
Q

asparaginase

A

enzyme
depletes asparaginase
given in week 1 and 3
side effects: skin reactions, hypersensitivity, blood clotting disorders, raised LFTs, pancreatitis

53
Q

aim of maintenance therapy

A

12 weeks
for 2 years in girls and 3 in boys
get rid of the few remaining leukaemia cells
MRD levels

54
Q

neutrophil count required for maintenance therapy to go ahead

A

greater than 0.75 x 10^9 per litre

55
Q

platelet count required for maintenance therapy to go ahead

A

greater than 75 x 10^9 per litre

56
Q

what are the drugs used in maintenance therapy

A

mercaptopurine
methotrexate

57
Q

mercaptopurine

A

purine antagonist
inhibit purine synthesis which interferes with DNA, RNA and protein synthesis
TMPT, thiopurine methyltransferase
side effects: thrombocytopenia, hepatotoxicity, myelosuppression

58
Q

methotrexate

A

antimetabolite
dihydrofolate reductase inhibitor, folate antagonist
given once weekly
side effects: mucositis

59
Q

what stresses do parents/families face with illnesses in family/kids

A
  1. illness-related factors, severity of child illness and type of health problem
  2. demographic factors, parent age, gender, socioeconomic status, ethnicity
    3.psychological factors, current parent mental health, trait anxiety, family functioning, family structure
60
Q

what stresses do parents/families have to face will illness in family/kids

A

difficult to relax
financial worries
difficult to remain positive
siblings display behaviour problems
having to remain strong

61
Q

support for leukaemia patients and their families

A

Leukaemia CARE
to ensure everyone gets best possible diagnosis, information, advice, treatment and support

62
Q

other charities to support leukaemia

A

blood cancer UK
leukaemia cancer society
B Positive

63
Q

impacts of leukaemia on mental health

A

increased risk of anxiety and depression
-social isolation
-reliant on others for support
-worry about relapse
-infertility
-appearance

64
Q

educational impacts of leukaemia

A

disruption to academic progress
treatments that suppress immune system leave you susceptible to other diseases, may further decrease academic progress
mild cognitive impairment

65
Q

positive impacts of leukaemia

A

personal growth and resilience
motivation
improved relationships with those close to them

66
Q

iron deficiency anaemia blood test results

A

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

67
Q

iron deficiency anaemia blood film results

A

smaller and paler RBC’s
ansiocytosis
poikilocytosis

68
Q

full blood count results for pernicious anaemia

A

low Hb
MCV higher

69
Q

blood film results perncious anaemia

A

abnormally large and shaped RBC’s
sometimes occasional giant WBC’s

70
Q

aplastic anaemia full blood count

A

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

Medicine: PBL wrap-ups (21 decks)

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