3: Concepts in malignant haematology

Question 1

How are

a) lymphoid
b) non-lymphoid white cells identified?

Answer 1

a) Immunophenotyping

b) Morphology

Question 2

How are progenitor blood cells identified?

Answer 2

Immunophenotyping

Question 3

What occurs in malignant haemopoiesis?

Answer 3

Increased numbers of dysfunctional cells

Loss of normal activity

Question 4

What problems occur in acute leukaemia?

Answer 4

Proliferation of ABNORMAL PROGENITOR CELLS

which DON’T DIFFERENTIATE OR MATURE

Question 5

Which two processes fail to occur in acute leukaemia?

Answer 5

Differentiation

Maturation

Question 6

What is the difference between acute leukaemia and chronic myeloproliferative disorders?

Answer 6

Acute leukaemia - proliferation of progenitor cells, NO DIFFERENTIATION OR MATURATION

Chronic myeloproliferative disorder - proliferation of progenitor cells, continued differentiation and maturation

Question 7

What is a clone?

Answer 7

Population of cells derived from a single parent cell

Question 8

A clone will have the same genetic ___ as its parent cell.

Answer 8

markers

Question 9

How is normal haemopoiesis described in terms of clones?

Answer 9

Polyclonal

Blood cells come from a variety of parent cells

Question 10

How is malignant haemopoiesis described in terms of clones?

Answer 10

Monoclonal

Cells derived from one abnormal parent cell

Question 11

Malignant haemopoiesis has a strong __ component.

Answer 11

genetic component

Question 12

What are the two lineages of haematological malignancy?

Answer 12

Myeloid

Lymphoblastic

Question 13

What are malignant blood cancers called when the

a) blood
b) lymph nodes are involved?

Answer 13

a) Leukaemia

b) Lymphoma

Question 14

What is myeloma?

Answer 14

Plasma cell malignancy IN the bone marrow

unfortunate naming not to be confused with myeloid leukaemias

Question 15

Acute leukaemias tend not to involve the ___ ___.

Answer 15

lymph nodes

Question 16

Chronic lymphoid leukaemias affect the ___ and ___ ___.

Answer 16

blood

bone marrow

but otherwise leukaemia means blood and lymphoma means lymph nodes

Question 17

Acute leukaemia causes the ___ ___ to fail.

Answer 17

bone marrow failure

because differentiation and maturation stop dead

Question 18

Describe the speed of onset of acute and chronic haematological malignancies.

Answer 18

Acute leukaemia - quick onset

Chronic - onset over weeks to months

Question 19

Which cells are affected in

a) myeloid malignancy
b) lymphoblastic malignancy
c) myeloma?

Answer 19

a) Non-lymphoid cells and their progenitors

b) Lymphoid cells and their progenitors

c) Plasma cells

Question 20

Which type of blood cancer is aggressive and rapidly progressing?

Answer 20

Acute leukaemia

Question 21

Acute leukaemia causes a LOSS OF HAEMOPOIETIC RESERVE.

Which investigation gives this away?

Answer 21

FBC

low platelets, white cells and RBCs

Question 22

Which malignancy affects primitive lymphoid cells?

Answer 22

Acute lymphoblastic leukaemia

Question 23

What is the most common childhood cancer?

Answer 23

Acute lymphoblastic leukaemia (ALL)

Question 24

What are the signs and symptoms of bone marrow failure caused by acute leukaemia?

Answer 24

Anaemic symptoms (fatigue, pallor, SOB, syncope, palpitations)

Abnormal bleeding

Increased infection risk

Question 25

What is unique about the presentation of **ALL?**

Answer 25

**Involvement of CNS, gonads i.e structures outwith the bone marrow**

Question 26

Which **acute blood malignancy** primarily affects a) **children** b) **adults**?

Answer 26

**a) Acute lymphoid leukaemia** **b) Acute myeloid leukaemia**

Question 27

Which **coagulation problem** is associated with **acute myeloid leukaemia**?

Answer 27

**DIC**

Question 28

How is **acute leukaemia** investigated?

Answer 28

**Full blood count** **Blood film** **Coagulation screen** (PT, APTT) **Bone marrow aspirate**

Question 29

What do **primitive progenitor cells** look like on a blood film?

Answer 29

**High nuclear:cytoplasmic ratio** **Dodgy looking**

Question 30

What is a **blood film finding** specific to **AML?**

Answer 30

**Auer rods**

Question 31

**AML** and **ALL** look similar morphologically. How do you tell them apart?

Answer 31

**Immunophenotyping**

Question 32

How **might** you tell the difference between **AML** and **ALL** morphologically?

Answer 32

**Auer rods specific to AML** but not there all the time

Question 33

Why is it important to determine whether a leukaemia is **myeloid** or **lymphoblastic**?

Answer 33

**Different treatments**

Question 34

How is **acute leukaemia** (ALL or AML) treated?

Answer 34

**Chemotherapy**

Question 35

**Acute leukaemia** AND the **chemotherapy** used to treat it cause **bone marrow suppression.** What are the complications of this?

Answer 35

**Anaemia** **Neutropaenia \> Infection** **Thrombocytopaenia \> Bleeding**

Question 36

Patients undergoing **chemotherapy** for **acute leukaemia** are susceptible to which infection?

Answer 36

**Gram negative bacteria** E. coli, Pseudomonas, Neisseria, Haemophilus, Chlamydia...

Question 37

Apart from **bone marrow suppression**, what are the generalised side effects of chemotherapy?

Answer 37

**N&V** **Hair loss** **Lethargy** **Hepatic and renal dysfunction**

Question 38

What is **tumour lysis syndrome?**

Answer 38

**Metabolic and electrolyte disturbances caused by tumour lysis in chemotherapy**

Question 39

What do you do if a patient undergoing **chemotherapy** has **neutropaenia** and a **fever?**

Answer 39

**Empirical antibiotic treatment** **Empirical anti-fungal treatment if they don't respond to that**

Question 40

What is an **important side effect** of **anthracycline chemotherapy?**

Answer 40

**Cardiomyopathy**

Question 41

A subtype of **which acute leukaemia** is associated with **coagulopathy?** ## Footnote **Which specific coagulopathy?**

Answer 41

**AML** **DIC**