Week 2 Flashcards
Name the 4 types of leukaemia?
Acute lymphoblastic leukaemia
Acute myeloid leukaemia
Chronic lymphocytic anaemia
Chromic myeloid leukaemia
What is acute leukaemia?
Rapidly progressing clonal malignancy of marrow/blood
What % of blasts in blood is defined as acute leukaemia?
20% or more
At what ages are the two types of leukaemia most common?
Lymphoblastic - childhood - most common childhood cancer
Myeloid - elderly
What is the only definitive way to tell ALL and AML apart?
Immunophenotyping
What is the difference in treatments between ALL and AML?
ALL - chemotherapy can last 2-3 years
AML - Chemo more intensive - 2-4 cycles of 5-10 days
What device is often used to give chemotherapy?
Hickman line
What haematological complications may arise from chemotherapy?
Anaemia
Neutropenia - infections
Thrombocytopenia - bleeding - purpura, petechiae
What is the cure rate for childhood ALL?
85-95%
What sort of transplant may be curable for acute leukaemia?
Allogenic stem cell transplant
Normal and malignant haemopoiesis - polyclonal or monoclonal?
Normal - polyclonal
Malignant - monoclonal
Name 3 symptoms of lymphoma?
Night sweats Weight loss Itch without rash Alcohol induced pain Fatigue Lymphadenopathy
What are the categories of lymphoma?
Hodgkins
Non-hodgkins - T cell or B cell (low grade B cell, high grade B cell)
Which lymphoma is the hardest to treat - low grade or high grade?
Low grade
Why are lymphoma lymph nodes not painful?
Because they enlarge slowly
Why do metastatic lymph nodes feel irregular?
Because the cancer cells grow out of the node
Are lymphoma nodes tender?
No
What is a blast?
Nucleated precursor cell
What is the life span of a RBC?
120 days
What is the lifespan of a neutrophil?
7-8 hours
What is the lifespan of a platelet?
7-10 days
What is a megakaryocyte?
Platelet precursor
What are immunoglobulins made of?
2 light and 2 heavy chains
Which is the most common type of myeloma?
IgG
What is the second most common type of myeloma?
IgA
Why is renal impairment seen in myeloma?
Light chains form casts which block the nephrons
Why does bone pain occur in myeloma?
Excessive stimulation of osteoclasts causing lytic lesions and hypercalcaemia
What are bence jones proteins and in what condition would you see them?
Light chains in the urine - myeloma
What type of immunoglobulin is a pentamer?
IgM
What type of immune globulin is a dimer?
IgA
What type of immunoglobulin is a monomer?
IgD, IgE, IgG
What type of anaemia may be seen in myeloma?
Normochromic normocytic anaemia
What is the average survival for patients with myeloma?
5-8 years
What drugs should you avoid in Myeloma and why?
NASIDS - can tip patients into renal failure
What is a paraprotein and what happens to it in myeloma?
A monoclonal immunoglobulin - rises in myeloma
What percentage of bone marrow is plasma cells in myeloma and MGUS?
Myeloma more than 10%
MGUS - less than 10%
What is the risk of progression from MGUS to Myeloma?
1%
What does amyloidosis stain with?
Congo red - birefringent
What paraprotein is involved in waldenstroms macroglobulinaemia?
IgM
What is Pancytopenia?
A deficiency of blood cells in all lineages
What are the two main causes of pancytopenia?
Reduced production and increased destruction
What sort of condition if fanconia anaemia?
Inherited bone marrow failure
What % of patients with fanconis anaemia will have bone bone marrow failure by age 20?
84%
What % of patients with fanconis anaemia will have leukaemia by age 40?
52%
What are the 3 phases of chronic myeloid leukaemia?
Chronic
Accelerated
Blast crisis
Name 4 lab features of CML?
Normal or decreased Hb Leucocytosis Neutrophilia Basophilia Eosinophlia Thrombocytosis Myeloid precursors
What chromosome is involved in CML and what is it?
Philadelphia chromosome
Reciprocal translocation between 9 and 22
What gene is present in CML and what does this produces?
BCR-ABL - produces tyrosine kinase
What targeted treatment is useful in CML and what does it do?
Imatinib - tyrosine kinase inhibitor
What lab counts are raised in polycythaemia rub vera?
Hb and haematocrit, erythrocytosis
And blood viscosity
What is a cause of pseudo polycythaemia?
Dehydration, diuretics, obesity
What gene is mutated in 95% of PRV?
JAK2
What is the treatment of PRV?
Venesect hct to less than 0.45
What abnormality causes essential thrombocythaemia?
Uncontrolled productions of abnormal platlets
Name 3 conditions that should be excluded before making a diagnosis of ET?
Blood loss, inflammation, malignancy, iron deficiency
In what % of ET patients it JAK 2 present?
50%
What characteristic feature is seen on blood film in myelofibrosis?
Tear drop Red cells
Name a Jak2 inhibitor?
Ruxolitinib
What are the 2 groups of cell cycle specific cytotoxic drugs?
Mitotic spindle inhibitors - M phase
Anti metabolites - S phase
What are the 2 groups of non cell cycle specific cytotoxic drugs?
Alkylating agents
Cytotoxic antibiotics
Name 2 High grade non hodgkin B cell lymphoma?
Diffuse large B cell
Burkitt lymphoma
Name 3 low grade non hodgkin B cell lymphoma?
Small lymphocytic
Follicular
Marginal
What % of NHL is T cell?
10-15%
What are the categories of hodgkin lymphoma?
Nodular
Classic
What is the characteristic histology finding in hodgkin lymphoma?
Reed steenburg cells
What staging system is used for hodgkin lymphoma?
Cotswalds system
What is the difference between acute and chronic leukaemia?
Acute - maturation defect
Chronic - maturation preserved
What % of blasts is considered remission in acute leukaemia?
Less than 5 %
What is the cure rate for adult AML?
Under 60 - 40-50%
Over 60 - 10% or less
What is the name given to red lines on the skin spreading from a skin lesion?
Lymphangitis
What is the arterial and venous supply to the spleen?
Splenic artery
Splenic vein
What causes Howell-Jolly bodies?
Hyposplenism
What is CD20?
B cell marker
What is CD3?
T cell marker
