acute leukaemia

Question 1

define acute leukaemia

Answer 1

accumulation of early myeloid or lymphoid precursors in the bone marrow, blood and other tissues.

Question 2

3 most likely causes of acute leukaemia

Answer 2

somatic mutation in early progenitor cells.
terminal event in a pre–existing blood disorder e.g. myeloproliferative disease.
chemotherapy.

Question 3

what are the 2 main subgroups of acute leukaemia

Answer 3

acute myeloid leukaemia

acute lymphoblastic leukaemia.

Question 4

Histological appearance of AML

Answer 4

blast cells in the peripheral blood
high white cell count, large immature cells with nuclei still present
high nucleus to cytoplasmic ratio and contains granules.

Question 5

Histological appearance of ALL

Answer 5

blast cells in the peripheral blood- smaller and rounder than in AML
smaller cytoplasm than AML

Question 6

what are the most common clinical presentations of acute myeloid leukaemia

Answer 6

• bone marrow failure
• anaemia
• infections (staphylococcus aureus, perianal, oral candida)
• bruising and haemorrhage.
• DIC
• lymph gland swelling (groin, axilla, cervical)
• hepatomegaly.
• gum hypertrophy

Question 7

what are the most common clinical features of acute lymphoblastic leukaemia

Answer 7

Oral candida.

Question 8

diagnosis of leukaemia.

Answer 8

morphology
cytochemistry
flow cytometry- immunological markers
cytogenetics- FISH for genetic leukaemia's
molecular techniques- PCR for mutations

Question 9

What are the 2 types of classifications of AML

Answer 9

FAB-morphologically based on what is seen.

WHO- classification is risk adapted.

Question 10

what immunological markers are used to determine leukaemia

Answer 10

monoclonal antibodies determination

Immunofluorescence (in particular FACS- fluorescence activated cell sorting).

Question 11

how does flourochrome-coupled antibody labelling work.

Answer 11

• Cell surface covered with antigens
• Antibody with flurochrome attaches,
• Cells streamed into a single line, pass laser beam which shines beam,
• They absorb light and then give of a specific wavelength to the colour they are.

Question 12

which genetic abnormality has a good prognosis in AML

Answer 12

t(8;21) and t(15:17)

Question 13

which genetic abnormality has bad prognosis in AML

Answer 13

monosomy 7

Question 14

what are the different types of chromosomal abnormalities in ALL

Answer 14

high hyperdiploidy
hyperdiploidy
pseudodiploidy
hypodiploidy

Question 15

what define high hyperdiploidy

Answer 15

> 50 chromosomes.

Question 16

what are the 2 types of chromosomal abnormalities in ALL

Answer 16

structural and numerical.

Question 17

what factors result in poor prognosis for ALL

Answer 17

age
WBC count
Males- ALL develops in the testes.
cytogenetic abnormalities
poor response to treatment
T-ALL and null ALL

Question 18

how are molecular abnormalities monitor in acute leukaemia

e.g. where are the results obtained from

Answer 18

bone marrow and peripheral blood.

Question 19

What is the molecular pathology of AML (what causes AML)

Answer 19

abnormal cell proliferation
block in differentiation
Tumour suppression

Question 20

Management of AML

Answer 20

• Induction treatment to obtain remission, then consolidation with further courses of combination chemotherapy
younger patient- bone marrow transplant.

Question 21

management of ALL

Answer 21

All patients receive induction chemotherapy, intensive consolidation chemotherapy and prophylaxis of meningeal leukaemia with intrathecal methotrexate and cranial irradiation
Chemotherapy and bone marrow transplant

Question 22

how is bone marrow obtained

Answer 22

Siblings-25% chance of full HLA match.
Cord blood transplant= collected at birth.
Donor list.

Question 23

what is Peripheral Blood Stem Cell Transplantation

Answer 23

Bone marrow cells are forced into peripheral blood

Question 24

what condition is will a patients undergoing chemotherapy develop

Answer 24

neutropenia

Question 25

define neutropenic fever

Answer 25

pyrexia in the presence of a neutrophil count of less than 1.0 x 109/l

Question 26

what are patients who develop neutropenia at risk of

Answer 26

neutropenic sepsis- developing overwhelming gram negative or gram positive infection

Question 27

how is neutropenic sepsis managed in order to reduce the risk of infection

Answer 27

immediate administration of broad spectrum IV antibiotics (often Tazocin and Gentamicin

Question 28

how can neutropenic sepsis be prevented

Answer 28

protective isolation
prophylactic antibiotics
use of granulocyte colony stimulating
education