Haematology 10: CML And Myeloproliferative Disorders Flashcards

1
Q

What is the difference between relative (pseudo) and true Polycythaemia ?

A

Relative: low plasma volume, normal Hb, high haematocrit
True: normal plasma volume, high Hb, high haematocrit

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2
Q

List 4 myeloproliferative disorders ?

A

Polycythaemia Vera
Essential thrombocytopenia
Primary myelofibrosis
CML

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3
Q

If a person has 18% myeloblasts do they have

A) MDS
B) CML
C) ALL
D) AML

A

A)-MDS

MDS is 5-19% blasts
AML is 20% + blasts
CML has fully differentiated but overproduced Myelocytes
ALL is lymphocytic not myeloid

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4
Q

What is the physiological role of Tyrosine kinases ?

A

Phosphorylate genes that cause cell growth (increased myeloid cell production)

They do not affect differentiation just proliferation

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5
Q

Which gene is most commonly mutated in polycythaemia rubra Vera ?

A

JAK2

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6
Q

What affect does JAK2 mutation have on erythropoeisis ?

A

JAK2 normally phosphorylates EPO receptors in response to EPO.
When mutated this process is constitutively activated so erythropoiesis occurs without regulation by EPO

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7
Q

What is the most pathognomonic sign/symptom of polycythaemia rubra Vera ?

A

Aquatic pruritus- hot baths causing itching

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8
Q

Give 2 treatments of polycythaemia rubra Vera ?

A

Hydroxycarbamide

Venesection

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9
Q

Which leukaemia is associated with massive Splenomegaly and hepatomegaly ?

A

CML

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10
Q

What are the 3 phases of CML ?

A

Chronic phase
Accelerated phase
Blast crisis

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11
Q

What is the most common chromosomal abnormality in CML ?

A

t(9;22)- BCR-ABL

Philadelphia chromosome

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12
Q

Which modality is useful for monitoring treatment response in CML ?

A

RT-PCR (reverse transcriptase)

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13
Q

What is the 1st line treatment for CML ?

A

Imatinib (tyrosine kinase inhibitor)

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14
Q

Which test allows you to tell the difference between reactive neutrophilia and leukaemia neutrophilia (CML) ?

A

Leukocyte alkaline phosphatase

Low in CML
Normal/ High in reactive neutrophilia

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15
Q

list appropriate causes of raised erythropoietin

A

high altitude
hypoxic lung disease
cyanotic heart disease
high-affinity haemoglobin

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16
Q

list Philadelphia negative myeloproliferative neoplasms

A

PV
ET (essential thrombocytopaenia)
PMF (primary myelofibrosis)

17
Q

list different myeloid malignancies

A

AML
Myelodysplasia
Myeloproliferative disorders
CML

18
Q

list different lymphoid malignancies

A

precursor cell malignancy eg ALL (B and T cell)

mature cell malignancy eg CLL, MM, lymphoma (H+ NH)

19
Q

what does a mutation in TK genes result in

A

expansion of mature cells

20
Q

what mutations are associated with myeloproliferative disorders

A

JAK 2 (V617F) - PV (100%), ET, PMF
Calreticulin - ET and PMF
MPL - ET

21
Q

symptoms of PV

A

hyperviscocity:
- headaches, light headedness, stroke, visual dist, fatigue, dyspnoea

increased histamine release:
- aquagenic pruritus, peptic ulceration

22
Q

symptoms of ET

A

bimodal (30, 55)
incidental finding in 50%

thrombosis:
- CVA, gangrene, TIA, DVT, PE

bleeding:
- mucous membranes and cutaneous

23
Q

treatment for ET

A

aspirin
hydroxycarbamide (antimetabolite that suppresses cell turnover)
anagrelide (inh pl but rarely used)

24
Q

prognosis for ET

A

normal life span in many
leukaemic transformation in 5% over 10 yrs
myelofibrosis uncommon

25
Q

define myelofibrosis

A

clonal myeloproliferative disease associated with reactive BM fibrosis
extra medullary haematopoiesis
60-70 yrs

26
Q

symptoms of myelofibrosis

A
cytopaenias
thrombosis
splenomegaly (MASSIVE)
hepatomegaly 
hypermetabolic state (B symptoms + hyperuricaemia)
27
Q

signs of myelofibrosis

A
leukoerythroblastic 
tear drop poikilocytes
giant platelets 
circulating megakaryocytes 
dry tap BM 
trephine biopsy - increased reticulin or collagen fibrosis 
spleen - intramedullary hematopoiesis 

JAK 2/ CALR mutation

28
Q

treatment for myelofibrosis

A
supportive - RBC and pl transfusion 
cytoreductive therapy - hydroxycarbamide
ruxolitinib - JAK2 inhibitor 
allogenic SC transplantation 
splenectomy
29
Q

features of CML

A

more common in M
40-60 yrs
radiation exposure = RF
chronic phase (5-6 yrs) - accelerated (6-12 m) - blast crisis (3-6m)
PHILADELPHIA CHROMOSOME - 22q, Bcr-abl, codes for a tyrosine kinase

30
Q

presentation of CML

A
lethargy
hypermetabolism 
thrombotic event 
mono-ocular blindness 
CVA 
bruising 
bleeding 
MASSIVE splenomegaly /hepatomegaly 

massive leukocytosis
Hb and pl normal/ raised

blood film:
neutrophils, myelocytes not blasts, basophilia

31
Q

treatment for CML

A

1st gen tyrosine kinase inhibitor
- Imatinib

2nd gen
- Dasatinib, Nilotinib

3rd gen
- Bosutinib

Allogenic SC transplant