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Haematology Y3 > Leukaemia (zero to finals) > Flashcards

Leukaemia (zero to finals) Flashcards

1
Q

What is leukaemia?

A

Leukaemia is cancer of a particular line of stem cells in the bone marrow, causing unregulated production of a specific type of blood cell.

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2
Q

How many leaukaemia types are there?

A

4 types

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3
Q

How are the leukaemia types classified?

A

Classified depending on how rapidly they progress (chronic is slow and acute is fast) and the cell line that is affected (myeloid or lymphoid)

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4
Q

What is AML?

A

Acute myeloid leukaemia (rapidly progressing cancer of the myeloid cell line)

AML may result in a transformation from a myeloproliferative disorder and is associated with Auer rods

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5
Q

What is ALL?

A

Acute lymphoblastic leukaemia (rapidly progressing cancer of the lymphoid cell line)

ALL is the most common leukaemia in children and is associated with Down syndrome

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6
Q

What is CML?

A

Chronic myeloid leukaemia (slowly progressing cancer of the myeloid cell line)

CML has three phases, including a long chronic phase, and is associated with the Philadelphia chromosome

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7
Q

What is CLL?

A

Chronic lymphocytic leukaemia (slowly progressing cancer of the lymphoid cell line)

CLL is associated with warm haemolytic anaemia, Richter’s transformation and smudge cells

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8
Q

What is richter’s transformation?

A

The occurrence of an aggressive lymphoma in patients with a previous or concomitant diagnosis of chronic lymphocytic leukemia (CLL)

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9
Q

What are smudge cells?

A

Remnants of cells that lack any identifiable cytoplasmic membrane or nuclear structure.

Smudge cells, also called basket cells, are most often associated with abnormally fragile lymphocytes in disorders such as chronic lymphocytic leukemia (CLL).

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10
Q

What is the typical age range for leukaemia?

A

Most types of leukaemia occur in patients over 60-70.

The exception is acute lymphoblastic leukaemia, which most commonly affects children under five years.

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11
Q

Leakaemia presentation is usually non-specific. What are the potential presenting features?

A

Fatigue
Fever
Pallor due to anaemia
Petechiae or bruising due to thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
Failure to thrive (children)

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12
Q

What is one key presenting feature of leukaemia?

A

Bleeding under the skin due to thrombocytopenia.

Bleeding under the skin causes non-blanching lesions.

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13
Q

How are the non-blanching lesions categorised in leukaemia?

A

These lesions are called different things based on the size of the lesions:

Petechiae are less than 3 and caused by burst capillaries
Purpura are 3 – 10mm
Ecchymosis is larger than 1cm

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14
Q

What is a non-blanching rash?

A

Non-blanching rashes are rashes which do not disappear with pressure, particularly using the ‘glass test’.

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15
Q

What are the main differentials for a non-blanching rash caused by bleeding under the skin?

A

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

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16
Q

For suspected leukaemia, when should a full blood count be done?

A

Within 48 hours for patients with suspected leukaemia.

A full blood count is the initial investigation.

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17
Q

What is a blood film used for in leukaemia?

A

A blood film is used to look for abnormal cells and inclusions.

18
Q

Where is a bone marrow biopsy usually taken from?

A

Bone marrow biopsy is usually taken from the iliac crest. It involves a local anaesthetic and a specialist needle.

19
Q

What are the 2 main options for a bone marrow biopsy?

A

The options are aspiration or trephine.

Bone marrow aspiration involves taking a liquid sample of cells from within the bone marrow.

Bone marrow trephine involves taking a solid core sample of the bone marrow and provides a better assessment of the cells and structure.

20
Q

What cell type is usually affected in ALL?

A

Affects one of the lymphocyte precursor cells, causing acute proliferation of a single type of lymphocyte, usually B-lymphocytes.

This replaces all other cells in the bone marrow leading to pancytopenia (overall low blood cells).

21
Q

Who is commonly affected with ALL?

A

ALL most often affects children under five but can also affect older adults. It is more common with Down’s syndrome.

Can be associated with philadelphia chromosome (but it is more associated with CML)

22
Q

What cell type is affected in CLL?

A

Chronic lymphocytic leukaemia is where there is slow proliferation of a single type of well-differentiated lymphocyte, usually B-lymphocytes.

It usually affects adults over 60 years of age.

23
Q

CLL usually presents with symptoms. True/false?

A

False

Usually asymptomatic.

But can present with infections, anaemia, bleeding and weight loss.

24
Q

What type of anaemia can CLL cause?

A

Warm autoimmune haemolytic anaemia

25
Q

What is Richter’s transformation in CLL?

A

Refers to the rare transformation of CLL into high-grade B-cell lymphoma.

26
Q

What are smudge/smear cells in CLL?

A

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.

27
Q

What are the 3 phases of CML?

A

Chronic phase

Accelerated phase

Blast phase

28
Q

What is the chronic phase of CML?

A

The chronic phase is often asymptomatic, and patients are diagnosed after an incidental finding of a raised white cell count.

This phase can last several years before progressing.

29
Q

What is the accelerated phase of CML?

A

The accelerated phase occurs when the abnormal blast cells take up a high proportion (10-20%) of the bone marrow and blood cells.

In the accelerated phase, patients are more symptomatic and develop anaemia, thrombocytopenia and immunodeficiency.

30
Q

What is the blast phase of CML?

A

The blast phase follows the accelerated phase and involves an even higher proportion (over 20%) of blast cells in the blood.

The blast phase has severe symptoms and pancytopenia and is often fatal.

31
Q

What chromosome is CML associated with?

A

“Philadelphia” chromosome

This refers to an abnormal chromosome 22 caused by a reciprocal translocation (swap) of genetic material between a section of chromosome 9 and chromosome 22.

32
Q

In CML, what does the translocation of chromosomes 9 and 22 cause?

A

This translocation creates an abnormal gene sequence called BCR-ABL1, which codes for an abnormal tyrosine kinase enzyme that drives the proliferation of the abnormal cells.

33
Q

What are characteristic features of AML?

A

A blood film and bone marrow biopsy will show a high proportion of blast cells.

Auer rods in the cytoplasm of blast cells are a characteristic finding in AML.

34
Q

What ages are usually affected by AML and how can it occur?

A

It can present at any age but normally presents from middle age onwards.

It can be the result of a transformation from a myeloproliferative disorder, such as polycythaemia ruby vera or myelofibrosis.

35
Q

How is leukaemia typically treated?

A

Leukaemia is mainly treated with chemotherapy and targeted therapies, depending on the type and individual features.

36
Q

What are some examples of targeted therapies for leukaemia?

A

Examples of targeted therapies include (mainly used in CLL):

Tyrosine kinase inhibitors (e.g., ibrutinib)
Monoclonal antibodies (e.g., rituximab, which targets B-cells)

37
Q

What are some side effects of chemotherapy?

A

Failure to treat cancer
Stunted growth and development in children
Infections due to immunosuppression
Neurotoxicity
Infertility
Secondary malignancy
Cardiotoxicity (heart damage)
Tumour lysis syndrome

38
Q

How does tumour lysis syndrome occur?

A

Tumour lysis syndrome results from chemicals released when cells are destroyed by chemotherapy

39
Q

Features of tumour lysis syndrome?

A

High uric acid
High potassium (hyperkalaemia)
High phosphate
Low calcium (as a result of high phosphate)

40
Q

What can tumour lysis syndrome lead to?

A

Uric acid can form crystals in the interstitial space and tubules of the kidneys, causing acute kidney injury.

Hyperkalaemia can cause cardiac arrhythmias. The release of cytokines can cause systemic inflammation.

41
Q

What can be used to reduce the risk of tumour lysis syndrome prior to chemotherapy?

A

Very good hydration and urine output before chemotherapy is required in patients at risk of tumour lysis syndrome.

Allopurinol or rasburicase may be used to suppress the uric acid levels.

Haematology Y3 (39 decks)

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