blood cell abnormality

Question 1

What is leukaemia

Answer 1

is essentially a bone marrow disease and overspill of the abnormal cells into the blood, producing white blood, is not essential for this diagnosis.

Question 2

b) How is leukaemia classified?

Answer 2

myeloid or lymphoid

Question 3

how does it differ from other cancers and why does that make it difficult to treat

Answer 3

cells circulate in the blood stream and migrate into tissues.difficult to apply the concepts of local invasion and metastasis that are used to describe solid tumours to populations of cells that are normally mobile.

Question 4

why can’t you use the terms malignant and benign when describing luekaemia

Answer 4

malignant and benign that are used to describe solid tumours are not usually applied to leukaemias

Question 5

what is acute l

Answer 5

if untreated, has profound pathological effects and leads to death in a matter of days, weeks or months

Question 6

chronic leukaemia

Answer 6

is one that causes less impairment of function of normal tissues and, although it will eventually lead to death, this usually does not occur for a number of years.

Question 7

why does leukaemia rise

Answer 7

mutations occurring in a primitive cell
growth or survival advantage over normal cells that have not undergone mutation
rise to a clone that steadily replaces normal cell

Question 8

what are the three forms of mutations in germ cells

Answer 8

beneficial, neutral or harmful; beneficial germline mutations permit the species to evolve.

Question 9

what can mutations in somatic cells lead to

Answer 9

leukaemia or other cancer

Question 10

cause of mutation

Answer 10

mutagens or it may be a random, spontaneous process

Question 11

The abnormal behaviour of the leukaemic clone can include growth that occurs without a dependence on growth factors, continued proliferation without maturation, and a failure to undergo normal cell death (apoptosis).

Answer 11

The abnormal behaviour of the leukaemic clone can include growth that occurs without a dependence on growth factors, continued proliferation without maturation, and a failure to undergo normal cell death (apoptosis).

Question 12

causes of l

Answer 12

unknown 
mutagenic drug 
exposure to irradiation 
chemical 
utero

Question 13

causes of acute

Answer 13

mutations in genes encoding transcription factors with a resultant profound abnormality in the cells ability to mature. However the cells continue to proliferate so that there is an accumulation of primitive cells referred to as blast cells

Question 14

causes of c

Answer 14

chronic myeloid leukaemia the mutation involves activation of signalling pathways within the cell (in CML this results from the fusion protein BCR-ABL1 encoded by the t(9;22) Philadelphia chromosome). Cells can then proliferate without needing growth factors
however maturation still occurs and, in the case of myeloid cells, mature end cells are still able to function. The impairment of normal physiological processes is therefore much less than in the acute leukaemia

Question 15

what do the signs and symptoms of leakiuma result from

Answer 15

direct and indirect

Question 16

what are direct causes

Answer 16

The direct effects of the proliferation of the leukaemic cells, e.g. bone pain, enlarged liver (hepatomegaly), enlarged spleen (splenomegaly) and swollen lymph nodes (lymphadenopathy, mainly in lymphoid leukaemias)

Question 17

what are indirect causes

Answer 17

The indirect effect of leukaemic cell proliferation, which leads to replacement of normal bone marrow cells by leukaemic cells (causing anaemia, thrombocytopenia, neutropenia).

Question 18

clinical features

Answer 18

fatigue, lethargy, pallor (anaemia)
fever and infections (neutropenia)
bruising and petechiae (thrombocytopenia)
bone pain (bone marrow expansion)
abdominal enlargement (hepatomegaly, splenomegaly)
lumps and swellings (lymphadenopathy)

Question 19

what are the essential investigations

Answer 19

full blood count and blood film
profile of the cell surface markers expressed (e.g. to distinguish T and B lymphoid cells); we do this using a technique called flow cytometry.
look for markers such as the Philadelphia chromosome (9;22)

Question 20

what is a major sign of cll

Answer 20

a ‘smear’ or ‘smudge’ cell: characteristic of CLL

Question 21

what is aneamia

Answer 21

Anaemia is a reduction in the haemoglobin concentration (Hb) in the circulating blood below what is normal for a healthy person of the same age and gender as the individual.

Question 22

what is associate with aneamia (lab tests)

Answer 22

with a reduction in the red blood cell count (RBC) and the haematocrit (Hct) (previously referred to as packed cell volume (PCV))

Question 23

what 4 can result in anaemia

Answer 23

Reduced production of red cells by the bone marrow
Loss of blood from the body
Reduced survival of red cells in the circulation (haemolysis)
Increased pooling of red cells in an enlarged spleen

Question 24

causes of microcytosis

Answer 24

Iron deficiency anaemia
Anaemia of chronic disease
Thalassaemia
reduced synthesis of haemoglobin. This can be caused by reduced synthesis of haem (iron deficiency or anaemia of chronic disease) or reduced synthesis of globin (thalassaemia).

Question 25

symptoms of iron defiency

Answer 25

pallor fatihue breathlessness

Question 26

what is anaemia of chronic disease

Answer 26

reduced synthesis of haemoglobin. This can be caused by reduced synthesis of haem (iron deficiency or anaemia of chronic disease) or reduced synthesis of globin (thalassaemia).

Question 27

what affect can cytokines and il have

Answer 27

cytokines such as TNF alpha and interleukins in chronic disease lead to a decrease in erythropoietin production and also prevent the normal flow of iron from the duodenum to the red blood cells

Question 28

Laboratory clues of anaemia of chronic disease

Answer 28

C-reactive protein is high (unlike iron deficiency)
Erythrocyte sedimentation rate (ESR) is high (unlike iron deficiency)
Ferritin is high
Transferrin is low
Acute phase proteins increase

Question 29

difference between iron defiency or acd

Answer 29

ferritin is low in id but high in acd

transferrin is high in id but low in acd

Question 30

what does macrocytes result from

Answer 30

abnormal heamopoiesis

red cell precursors sythesis hb but can’t divide so larger

Question 31

how does magloblastic anaemia cause macrocytosis

Answer 31

delay in maturation of the nuclues
while cytoplasm continues to mature
cell grows
magloblast seen in bone marrow not blood film

Question 32

what is a magloblast

Answer 32

abnormal bone marrow erythroblast

Question 33

What is the mechanism of normocytic a

Answer 33

loss of blood
failure of production of rbc
pooling of rbc in spleen

Question 34

what does an increase in reticlucytes mean

Answer 34

An increased reticulocyte count is seen as a response to haemolytic anaemia and recent blood loss and also as a response to treatment with iron, vitamin B12 or folic acid

Question 35

what does A reduced reticulocyte mean

Answer 35

count is seen when there is reduced output of red cells from the bone marrow.

Question 36

how to treat id

Answer 36

Iron replacement therapy such as ferrous sulphate tablets can be given. Although the anaemia will improve with iron replacement, it is very important to ascertain the cause of the anaemia.