Flashcards in Acute Leukaemia Deck (18)
What is acute leukaemia?
The accumulation of early MYELOID or LYMPHOID precursors in the BONE MARROW and other tissues
What is leukaemia usually the result of?
Mutations in haemopoietic stems cells
- Cannot differentiate into mature blood cells
What are the two main types of leukaemia?
(further divided into various subgroups)
What are the features of blast cells in AML?
-High nucleus:cytoplasm ratio
- presence of granule
What are the feature of blast cells in ALL?
Higer nucleus:cytoplasm ration (very little cytoplasm)
- smaller than AML blasts
What are the clinical features of acute leukaemia? What are the specific
Anaemia - hypochromic, microcytic
Infection (immunocompromised e.g. candida, perianal infection - E coli, strep faecalis)
Early bruising/haemorrhage - thrombocytopenia
Organ infiltration by leukaemia cells e.g. spleen, liver, meninges, testes, skin
How is acute leukaemia diagnosed?
Morphology - look at cells!
How are acute myeloid leukaemia classified? What are the two classification systems and what do they look at?
French American and British (FAB) - morphological features - see different points in maturation
WHO - risk adapted
How does immunological markers work?
Monoclonal antibodies with fluorochrome attached added
Attached to cell surface antigens
Fluorochrome absorbs light and releases wavelength
- Indicates presence of antigens which = diagnostic
What is trisomy 9:22? (T(9;22))
Philadelphia chromosome - driver for chronic myeloid leukaemia
What cytogenetic abnormalities are associated with a good and bad prognosis of Acute leukaemia?
T(15:17) (T8:21) = good prognosis
Mysomy -5, -7 = bad
What type of chromosomal abnormalities are associated with ALL?
Abnormalities in number of chromosomes
What are the poor prognostic factors for ALL?
-Increasing age (>10yrs)
-High white cell count (>50)
-Cytogenetic abnormalities (discussed)
- T cell - ALL (worse than B-cell ALL)
What genetic mutations are associated with a good and poor diagnosis?
NPM1 = good
FLT3 - bad
What is the management for AML?
Chemotherapy - 4 courses - 2 intensive, 2 consolidation (obtain remission)
Bone marrow transplant in young patient
What is the management for ALL?
Induction and intensive consolidation chemotherapy
Prophylaxis of meningeal leukaemia with methotrexate
Bone marrow transplant in bad risk patients
What is neutropenic sepsis? How is it diagnoses>
Intensive chemotherapy will destroy patient neutrophils
Pyrexia with neutrophil count being less than 1 x19^9