Week 10: Lymphoproliferative disorders (leukaemia, myeloma, lymphoma)

Question 1

Describe pathophysiology of multiple myeloma

Answer 1

Cancer of bone marrow clonal plasma cells

Makes monoclonal Ab against RBC

Question 2

What blood tests features support a diagnosis multiple myeloma

Answer 2

1. Serum monoclonal protein
2. Serum IgG
3. High Ca2+
4. High serum creatinine

Question 3

Features of multiple myeloma in gel electrophoresis

Answer 3

• May show monoclonal protein

- May be normal (because patients are urinating out the light chains)

Question 4

Features of multiple myeloma in bone marrow biopsy

Answer 4

INCREASED ratio of plasma cells (>10%)

Question 5

What type of anaemia do multiple myeloma patients get

Answer 5

Normocytic anaemia

Question 6

Features of end organ damage in multiple myeloma

Answer 6

CRAB

1. Ca2+ increased
2. Renal failure
3. Anaemia
4. Bone lesions (lytic) –> may lead to cord compression

Question 7

Why does multiple myeloma result in kidney damage

Answer 7

Antibodies get caught in tubules and cause direct damage

Question 8

4 types of leukaemia

Answer 8

1. Chronic lymphocytic (CLL)
2. Chronic myeloid (CML)
3. Acute lymphoblastic (ALL)
4. Acute myeloid (AML)

Question 9

Most common form of leukaemia in children

Answer 9

Acute lymphoblastic leukaemia

Question 10

What does pancytopenia consist of

Answer 10

1. Anaemia
2. Neutropenia
3. Thrombocytopenia

Question 11

Presentation of acute leukaemia

Answer 11

Pancytopenia symptoms

• Anaemia: fatigue, angina
• Thrombocytopenia: bleeding/ petichiae
• Neutropenia: susceptibility to infections

General cancer symptoms: weight loss, sweats, anorexia, flu-like symptoms

Question 12

What may predispose someone to developing leukaemia

Answer 12

1. Genetics (eg Down’s syndrome increases risk by 100x)
2. Chemotherapy (tx for a previous cancer)
3. Haematological disease
4. Radiation

Question 13

Which type of leukaemia is most likely to cause meningitis

Answer 13

Childhood acute lymphoblastic leukaemia

Question 14

How do leukaemia cells look in histology

Answer 14

1. Large cells
2. Huge nuclei, nucleolus
3. Very little cytoplasm

Question 15

3 causes of bone marrow failure

Answer 15

1. Aplastic anaemia
2. Megaloblastic anaemia
3. Infiltration of bone marrow with cancer

Question 16

If a bone marrow biopsy shows too few cells, what is the cause of bone marrow failure

Answer 16

Aplastic anaemia

Question 17

If a bone marrow biopsy shows too many cells, what is the cause of bone marrow failure

Answer 17

Bone marrow infiltration by cancer

Question 18

Which 5 blood cancers can cause bone marrow failure

Answer 18

1. Acute leukaemia
2. Myeloma
3. Myeofibrosis
4. Lymphoma
5. Myelodysplastic syndrome

Question 19

Which are 6 cancers most commonly associated with bone mets (leading to bone marrow failure)

Answer 19

1. Breast
2. Prostate
3. Lung
4. Renal
5. Thyroid
6. Melanoma

Question 20

Difference between myelodysplasia and myeloproliferation

Answer 20

Myelodysplasia: baby RBC do not mature and don’t become healthy RBC

Myeloproliferation: too many blood cells

Question 21

How to differentiate bone marrow failure from haemolytic anaemia

Answer 21

Look at blood reticulocytes

Anaemia + low reticulocytes: BM failure

Anaemia + high reticulocytes: Haemolytic anaemia

Question 22

Complications of thrombocytopenia

Answer 22

• Intracerebral bleed

- GI bleed

Question 23

What neutrophil counts are considered

• mild
• moderate
• severe

Answer 23

Mild: 1-1.5
Moderate: 0.5-1
Severe: <0.5

Question 24

What platelets counts are considered

• mild
• moderate
• severe

Answer 24

Mild: 50-100
Moderate: 20-50
Severe: 0-20

Question 25

3 criteria in neutropenic sepsis

Answer 25

1. Pts undergoing chemotherapy 2. Neutrophils <0.5 3. Temperature >38C OR other signs/symptoms consistent with sepsis

Question 26

Chemo patients should be admitted at what neutrophil count

Answer 26

Admission with neutrophil count <1 + fever

Question 27

What treatments should be commenced for patients with suspected neutropenic sepsis

Answer 27

1. IV a/b: tazocin (dont give gentamycin for neutropenic sepsis even though it's given in PUO) 2. IV fluids (high risk of hypotension)

Question 28

What a/b can be given to patients at risk of developing neutropenia (to avoid sepsis)

Answer 28

Fluoroquinolone

Question 29

Causes of aplastic anaemia

Answer 29

- Usually idiopathic | - May be drug-induced (by chemotherapy, sulphonamides for RA)

Question 30

Causes of megaloblastic anaemia

Answer 30

B12/ folate deficiency

Question 31

Pathophysiology of aplastic anaemia

Answer 31

BM cells are replaced by fat -> results in pancytopenia

Question 32

Pathophysiology of megaloblastic anaemia

Answer 32

Low B12/ folate -> impaired DNA synthesis so cell cycle is arrested --> cell keeps growing without dividing -> macrocytosis