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Essential Haematology > 9. Acute leukemias > Flashcards

9. Acute leukemias Flashcards

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1
Q

Define Leukemias

A

They are a group of disorders characterized by the accumulation of malignant white cells in the bone marrow and blood

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2
Q

What are the four classifications of Leukemia

A

Acute lymphoid Leukemia
Acute myeloid Leukemia
Chronic Lymphoid Leukemia
Chronic Myeloid Leukemia

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3
Q

Describe the onset of Acute Leukemias

A

Aggressive disease in which malignant transformation occurs in the haemopoietic cell or early progenitors (blast cells)

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4
Q

What is the most common clinical feature of Acute Leukemias

A

Bone marrow failure

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5
Q

What causes bone marrow failure in Acute Leukemia

A

Caused by accumulation of blast cells in addition to organ infiltration

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6
Q

Define Acute Leukemia

A

The presence of over 20% of blast cells in the blood or bone marrow at clinical presentation

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7
Q

What are the two subdivisions of Acute Leukemias

A

Acute Myeloid Leukemia (AML)

Acute Lymphoblastic Leukemia (ALL)

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8
Q

What is the Morphological difference between ALL and AML

A

In ALL the blasts show no differentiation (with the exception of B-cell) whereas in AML some evidence of differentiation to granulocytes or monocytes is seen

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9
Q

What causes Acute Lymphoblastic Leukemia

A

An accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood

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10
Q

What is the most common malignancy of childhood

A

Acute Lymphoblastic Leukemia

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11
Q

What is the incidence of Acute Lymphoblastic Leukemia (ALL)

A

3-7 yrs

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12
Q

Based on morphology, what are the three subtypes of ALL (Acute Lymphoblastic Leukemias)

A

L1
L2
L3

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13
Q

Describe L1 ALL

A

Uniform, small blast cells with scanty cytoplasm

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14
Q

Describe L2 ALL

A

Type comprise larger blast cells with more prominent nucleoli and cytoplasm and more heterogeneity

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15
Q

Describe L3 ALL

A

Blasts that are large with prominent nucleoli, strongly basophilic cytoplasm and cytoplasmic vacuoles

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16
Q

What are the four subtypes of ALL based on Immunophenotype

A

Early pre B
Pre B
B- cell
T- cell

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17
Q

What are the two main features of ALL(Acute Lymphoblastic Leukemia)

A

Bone Marrow Failure

Organ Infiltration

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18
Q

What are three effects of Bone Marrow Failure

A

Anaemia
Neutropenia
Thrombocytopenia

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19
Q

What are three clinical features of Anemia

A

Pallor
Lethargy
Dyspnoea

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20
Q

What are three clinical features of neutropenia

A

Fever
Malaise
Mouth, throat, skin, respiratory, perianal infections

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21
Q

List four clinical features of Thrombocytopenia

A

Spontaneous bruises
Purpura
Bleeding gums
Menorrhagia

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22
Q

What are five common manifestations of Organ infiltration

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A 
Tender bones
Lymphadenopathy 
Moderate Splenomegaly
Hepatomegaly
Meningeal Syndrome
23
Q

What are five symptoms of Meningeal syndrome

Study These Flashcards
A 
Headache
Diplopia
Blurred vision
Nausea
Vomiting
24
Q

What are the results of haematologic tests in ALL and AML

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A

Normochromic
Normocytic
Thrombocytopenia
Total White Cell count may be decreased, normal or increased

25
What are the results of Blood film Examination in ALL and AML
Variable number of blast cells
26
What are the features of the bone marrow in ALL and AML
Hypercellular with >20% leukemia blasts
27
What is the result of Lumbar Puncture in ALL and AML
Spinal fluid has increased pressure | Spinal fluid contains leukemic cells
28
What is the result of Biochemical tests for ALL and AML
Raised serum uric acid | Raised serum lactate dehydrogenase
29
List some differential diagnosis for ALL
``` AML Aplastic anemia Marrow infiltration by other malignancy Infections Juvenile Rheumatoid Arthritis ```
30
B- ALL always has which ALL morphology
L3
31
What are two types of treatment for ALL
General Supportive therapy | Specific Therapy
32
Describe Specific Therapy of ALL
Chemotherapy | Radiotherapy
33
What is the aim of Remission Induction | Type of Specific Treatment for ALL
Rapidly kill most of the tumour cells and get the patient into remission.
34
Which drugs are used for remission induction treatment of ALL
Prednisolone or Dexmethasone (in children) Vincristine Asparaginase
35
Describe Intensification (consolidation) treatment for ALL
Uses high doses of multidrug | chemotherapy in order to completely reduce or eliminate the tumour burden to very low levels
36
What percentage of Acute Lymphoblastic Leukemias occur in children
80%
37
What percentage of Acute Lymphoblastic Leukemias occur in adults
20%
38
What percentage of Acute Myeloid Leukemias occur in children
20%
39
What percentage of Acute Myeloid Leukemias occur in adults
80%
40
What are 5 risk factors for leukemia
``` Ionizing radiation Benzene Down's Syndrome Chronic Smoking Klinefelter syndrome ```
41
T- ALL is most common in which sex
Males
42
What is the prognosis of ALL in children
Usually good ~90% of children can expect to be cured
43
What is the prognosis of ALL in adults
Poor | Adults over 70 yrs have <5% cure rate
44
What is the common form of Leukemia in adults
Acute Myeloid Leukemia AML
45
What fraction of childhood leukemias does Myeloid Leukemia form
10-15%
46
What are the two main types of Acute Myeloid Leukemia
Primary AML | Secondary AML
47
What is the genetic abnormality seen in Primary AML
Chromosomal translocations of t(8;21) And t(15;17)
48
What is the prognosis of primary AML
Good
49
What are the clinical features of AML
Anaemia Thrombocytopenia neutropenia
50
List one problem that is unique to AML and not ALL
Haemorrhagic syndrome | associated with the AML M3 variant
51
Haemorrhagic syndrome unique to AML is associated with which variant
M3 variant
52
How is Haemorrhagic Syndrome of AML treated
Multiple platelet transfusions | Replacement of clotting factors with fresh frozen plasma
53
CASE HISTORY// 6 yr old female with fever for 3 weeks, less active, easily tired, bleeding gums and easy bruising for 1 week Physical Examination - pale, febrile, tenderness over sternum - multiple haemorrhagic lesions - cervical nodes enlarged, non- tender - spleen enlarged BLOOD RESULTS// Hb 6.0 g/dl blood film - normochromic / normocytic Platelets : 12 x 10^9/L WBC : 85 x 10^9/L Chest X ray : enlarged nodes Bone marrow: 90% blasts with few erythroid and megakaryocyte precursors
Leukemia

Essential Haematology (14 decks)

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