Week 20 - Leukaemia, Lymphoma, Myeloma Flashcards
what is leukaemia
a cancer of a particular line of stem cells in the bone marrow, causing unregulated production of a specific type of blood cell
what are the four main types of leukaemia
- acute myeloid leukaemia
- acute lymphoblastic leukaemia
- chronic myeloid leukaemia
- chronic lymphocytic leukaemia
how are the types of leukaemia classed
depending on how rapidly they progress and the cell line that is affected
what is a more rare, less likely to appear in exams form of leukaemia
acute promyelocytic leukaemia
what leukaemia most commonly affects children under 5 years old
acute lymphoblastic leukaemia
which leukaemia is associated with Down’s syndrome and children
ALL
what leukaemia is associated with warm haemolytic anaemia, Richter’s transformation and smudge cells
CLL
how many phases does CML have and what is it associated with
has three phases, including a long chronic phase, and is associated with the Philidelphia chromosome
what may AML result in
a transformation from a myeloproliferative disorder and is associated with Auer rods
what does a genetic mutation in one of the precursor cells in the bone marrow lead to
excessive production of a single type of abnormal white blood cell
what can the excessive production of a single type of cells do to other cell lines
can suppress the other cell lines, causing the underproduction of different cell types.
this results in pancytopenia, which is a combination of low red blood cells , white blood cells and platelets
what are the potential presenting features for leukaemia
Fatigue
Fever
Pallor due to anaemia
Petechiae or bruising due to thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
Failure to thrive (children)
what is one key presenting feature of leukaemia
bleeding under the skin due to thrombocytopenia
what does bleeding under the skin cause
. Bleeding under the skin causes non-blanching lesions.
what are lesions of bleeding under the skin called; there are three names according to the different sizes
Petechiae are less than 3 and caused by burst capillaries
Purpura are 3 – 10mm
Ecchymosis is larger than 1cm
what are the top differentials for a non-blanching rash caused by bleeding under the skin
Leukaemia
Meningococcal septicaemia
Vasculitis
Henoch-Schönlein purpura (HSP)
Immune thrombocytopenic purpura (ITP)
Thrombotic thrombocytopenic purpura (TTP)
Traumatic or mechanical (e.g., severe vomiting)
Non-accidental injury
what do NICE recommend within 48 hours for patients with suspected leukaemia
a full blood count within 48 hours
what is used to look for abnormal cells and inclusions
a blood film
what is a very non-specific marker of tissue damage that is often raised in leukaemia
Lactate dehydrogenase (LDH)
it can be raised in literal heavy exercise too so it is not helpful for screeing
what is used to analyse the cells in the bone marrow to establish a definitive diagnosis of leukaemia
bone marrow biopsy
what are used to help stage the condition of leukaemia
CT and PET scans
where is a bone marrow biopsy usually taken from and what does it involve
the iliac crest
it involves a local anaesthetic and a specialist needle.
the options are aspiration or trephine. bone marrow aspiration involves taking a liquid sample of cells from within the bone marrow
what does bone marrow trephine involve
taking a solid core sample of the bone marrow and provides a better assessment of the cells and structure
what does ALL (acute lymphoblastic leukaemia) affect
ALL affects one of the lymphocyte precursor cells causing acute proliferation of a single type of lymphocyte, usually B lymphocyte
what does excessive accumulation of these cells lead to
replaces other cell types in the bone marrow leading to pancytopenia
what is chronic lymphocytic leukaemia
where there is a slow proliferation of a single type of well-differentiated lymphocyte, yet again usually the B lymphocyte
who does CLL usually affect
adults over 60 years of age
what does Richter’s transformation refer to
the rare transformation of CLL into high-grade B cell lymphoma
what are smear or smudge cells and what are they particularly associated with
Smear or smudge cells are ruptured white blood cells that occur while preparing the blood film when the cells are aged or fragile. They are particularly associated with chronic lymphocytic leukaemia.
what are the three phases of chronic myeloid leukaemia
chronic phase
accelerated phase
blast phase
what is the chronic phase of CML
often asymptomatic and patients are diagnosed after an incidental finding of a raised white cell count
this phase can last for several years before progressing
what is the accelerated phase of CML
occurs when the abnormal blast cells take up a high proportion of the bone marrow and blood cells
in the accelerated phase, patients are more symptomatic and devlop anaemia, thrombocytopenia and immunodeficiency
what phase does the blast phase come after
comes after the accelerated phase
what does the blast phase involve
an even higher proportion of blast cells in the blood
the blast phase has severe symptoms and pancytopenia,
it is often fatal
CML is associated with which chromosome
with the Philadelphia chromosome
this refers to an abnormal chromosome 22 caused by a reciprocal translocation of genetic material between a section of chromosome 9 and chromosome 22
what does this translocation in CML create
an abnormal gene sequence called BCR-ABL1 which codes for an abnormal tyrosine kinase enzyme that drives the proliferation of the abnormal cells
what is acute myeloid lukaemia presenation
normally presents form middle age onwards
what is AML a result of
transformation from a myeloproliferative disorder such as polycythaemia ruby vera or myelofiborisis
what will a blood film and bone marrow biopsy show in AML
show a high proportion of blast cells
auer rods in the cytoplasm of blast cells are a characteristc finding in AML
what is leukaemia mainly treated with
chemotherapy and targeted therapies, depending on the type and individual features
what are two examples of targeted therapies used in CLL
Tyrosine kinase inhibitors (e.g., ibrutinib)
Monoclonal antibodies (e.g., rituximab, which targets B-cells)
what are the other treatment options for leukaemia
radiotherapy
bone marrow transplant
surgery
what is tumour lysis syndrome and what does it result from
results from chemicals released when cells are destroyed by chemotherapy, resulting in;
- high uric acid
- hyperkalaemia
-high phosphate
- low calcium