Haematology 1 - Acute leukaemia

Question 1

What is the median age of presentation of AML?

Answer 1

65-70

Question 2

Recall some genetic associations of AML

Answer 2

t(8:21)- good prognosis M2 AML
t(15;17) - good prognosis M3 AML (APML)
inv(16) - good prognosis M4 AML (myelomonocytic)
Trisomy 21
5q deletion- bad prognosis
7q deletion

Question 3

Which type of leukaemia is most likely to cause haemorrhage?

Answer 3

Acute Promyelocytic leukaemia (APML)

Question 4

Which type of leukaemia is most likely to cause DIC?

Answer 4

APML

Question 5

What is the key triad of clinical features of AML?

Answer 5

Anaemia
Thrombocytopaenia
Neutropaenia

Question 6

Recall some clinical signs that can be used to identify AML

Answer 6

Hepatosplenomegaly
Monocytic gum infiltration (M5 AML)
CNS disease (More in ALL)
Occasional lymphadenopathy

Question 7

How can myeloid lineage be proved on blood film?

Answer 7

Presence of auer rods

Question 8

What is the most effective investigation for differentiating AML and ALL, and what results would it show for each?

Answer 8

Immunophenotyping:
AML: CD13/1/15
ALL: CD3/4/18/19/20

Question 9

Recall some useful supportive therapies for AML

Answer 9

Blood products: red cells, platelets and FFP
Antibiotics
Long line
Allopurinol (as uric acid may be released from dying cells when treatment is started)

Question 10

Which type of leukaemia is most likely to present with long bone pain?

Answer 10

ALL

Question 11

Recall some sights of leukaemic involvement in ALL that you wouldnt see in AML

Answer 11

Thymus, testes, CNS

Question 12

Which ALL patients are appropriate for imatinib treatment?

Answer 12

Philadelphia chromosome positive

Question 13

Treatment for APML

Answer 13

ATRA (retinoic acid)

Often do not need chemo

Question 14

AML Chemotherapy

Answer 14

Remission: Daunorubicin, cytarabine (damage dna-prevent synthesis)

Consolidation: cytarabine