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Flashcards in acute leukaemia Deck (28):
1

define acute leukaemia

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

2

3 most likely causes of acute leukaemia

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

3

what are the 2 main subgroups of acute leukaemia

acute myeloid leukaemia
acute lymphoblastic leukaemia.

4

Histological appearance of AML

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.

5

Histological appearance of ALL

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

6

what are the most common clinical presentations of acute myeloid leukaemia

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

7

what are the most common clinical features of acute lymphoblastic leukaemia

Oral candida.

8

diagnosis of leukaemia.

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

9

What are the 2 types of classifications of AML

FAB-morphologically based on what is seen.
WHO- classification is risk adapted.

10

what immunological markers are used to determine leukaemia

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

11

how does flourochrome-coupled antibody labelling work.

• 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.

12

which genetic abnormality has a good prognosis in AML

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

13

which genetic abnormality has bad prognosis in AML

monosomy 7

14

what are the different types of chromosomal abnormalities in ALL

high hyperdiploidy
hyperdiploidy
pseudodiploidy
hypodiploidy

15

what define high hyperdiploidy

>50 chromosomes.

16

what are the 2 types of chromosomal abnormalities in ALL

structural and numerical.

17

what factors result in poor prognosis for ALL

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

18

how are molecular abnormalities monitor in acute leukaemia
(e.g. where are the results obtained from)

bone marrow and peripheral blood.

19

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

abnormal cell proliferation
block in differentiation
Tumour suppression

20

Management of AML

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

21

management of ALL

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

22

how is bone marrow obtained

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

23

what is Peripheral Blood Stem Cell Transplantation

Bone marrow cells are forced into peripheral blood

24

what condition is will a patients undergoing chemotherapy develop

neutropenia

25

define neutropenic fever

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

26

what are patients who develop neutropenia at risk of

neutropenic sepsis- developing overwhelming gram negative or gram positive infection

27

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

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

28

how can neutropenic sepsis be prevented

protective isolation
prophylactic antibiotics
use of granulocyte colony stimulating
education