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Stage 4: CSIM 2 > Week 10: Lymphoproliferative disorders (leukaemia, myeloma, lymphoma) > Flashcards

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

1
Q

Describe pathophysiology of multiple myeloma

A

Cancer of bone marrow clonal plasma cells

Makes monoclonal Ab against RBC

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2
Q

What blood tests features support a diagnosis multiple myeloma

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

Features of multiple myeloma in gel electrophoresis

A
  • May show monoclonal protein

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

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4
Q

Features of multiple myeloma in bone marrow biopsy

A

INCREASED ratio of plasma cells (>10%)

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5
Q

What type of anaemia do multiple myeloma patients get

A

Normocytic anaemia

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6
Q

Features of end organ damage in multiple myeloma

A

CRAB

  1. Ca2+ increased
  2. Renal failure
  3. Anaemia
  4. Bone lesions (lytic) –> may lead to cord compression
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7
Q

Why does multiple myeloma result in kidney damage

A

Antibodies get caught in tubules and cause direct damage

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8
Q

4 types of leukaemia

A
  1. Chronic lymphocytic (CLL)
  2. Chronic myeloid (CML)
  3. Acute lymphoblastic (ALL)
  4. Acute myeloid (AML)
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9
Q

Most common form of leukaemia in children

A

Acute lymphoblastic leukaemia

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10
Q

What does pancytopenia consist of

A
  1. Anaemia
  2. Neutropenia
  3. Thrombocytopenia
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11
Q

Presentation of acute leukaemia

A

Pancytopenia symptoms

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

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

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12
Q

What may predispose someone to developing leukaemia

A
  1. Genetics (eg Down’s syndrome increases risk by 100x)
  2. Chemotherapy (tx for a previous cancer)
  3. Haematological disease
  4. Radiation
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13
Q

Which type of leukaemia is most likely to cause meningitis

A

Childhood acute lymphoblastic leukaemia

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14
Q

How do leukaemia cells look in histology

A
  1. Large cells
  2. Huge nuclei, nucleolus
  3. Very little cytoplasm
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15
Q

3 causes of bone marrow failure

A
  1. Aplastic anaemia
  2. Megaloblastic anaemia
  3. Infiltration of bone marrow with cancer
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16
Q

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

A

Aplastic anaemia

17
Q

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

A

Bone marrow infiltration by cancer

18
Q

Which 5 blood cancers can cause bone marrow failure

A
  1. Acute leukaemia
  2. Myeloma
  3. Myeofibrosis
  4. Lymphoma
  5. Myelodysplastic syndrome
19
Q

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

A
  1. Breast
  2. Prostate
  3. Lung
  4. Renal
  5. Thyroid
  6. Melanoma
20
Q

Difference between myelodysplasia and myeloproliferation

A

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

Myeloproliferation: too many blood cells

21
Q

How to differentiate bone marrow failure from haemolytic anaemia

A

Look at blood reticulocytes

Anaemia + low reticulocytes: BM failure

Anaemia + high reticulocytes: Haemolytic anaemia

22
Q

Complications of thrombocytopenia

A
  • Intracerebral bleed

- GI bleed

23
Q

What neutrophil counts are considered

  • mild
  • moderate
  • severe
A

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

24
Q

What platelets counts are considered

  • mild
  • moderate
  • severe
A

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

25
Q

3 criteria in neutropenic sepsis

A
  1. Pts undergoing chemotherapy
  2. Neutrophils <0.5
  3. Temperature >38C OR other signs/symptoms consistent with sepsis
26
Q

Chemo patients should be admitted at what neutrophil count

A

Admission with neutrophil count <1 + fever

27
Q

What treatments should be commenced for patients with suspected neutropenic sepsis

A
  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)
28
Q

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

A

Fluoroquinolone

29
Q

Causes of aplastic anaemia

A
  • Usually idiopathic

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

30
Q

Causes of megaloblastic anaemia

A

B12/ folate deficiency

31
Q

Pathophysiology of aplastic anaemia

A

BM cells are replaced by fat -> results in pancytopenia

32
Q

Pathophysiology of megaloblastic anaemia

A

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

Stage 4: CSIM 2 (47 decks)

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