Concepts in Malignant Haematology

Question 1

how do you identify non-lymphoid cells from lymphoid cells?

Answer 1

morphology eg by blood count or film

Question 2

how can you identify normal stem cells from other cells?

Answer 2

immunophenotyping

Question 3

CD34 is an antigen often expressed on what cells…

Answer 3

stem cells

Question 4

malignant haemopoiesis is characterised by 2 things, what are they?

Answer 4

inc numbers of abnormal + dysfunctional cells

loss of normal activity

Question 5

what can cause blood cells to become dysfunctional or abnormal?

Answer 5

inc proliferation

lack of differentiation/maturation/apoptosis

Question 6

what is the problem in acute leukaemia?

Answer 6

problem with differentiation/maturation of progenitor cells

Question 7

describe levels of progenitor and differentiated cells in leukaemia

Answer 7

high progenitor cells (cant divide)

low differentiated cells

Question 8

what kind of leukaemia DOES have normal differentiation of cells

Answer 8

chronic (only acute doesnt have differentiation of cells)

Question 9

what is the problem in chronic leukaemia?

Answer 9

too many normal cells

differentiation/maturation is normal

Question 10

what kind of mutation causes clonal expansion?

Answer 10

driver mutation

Question 11

what is a “clone” in genetics

Answer 11

population of daughter cells derived from a single parent cells

Question 12

how are clones helpful in cancer?

Answer 12

the parent cell has a genetic marker so you can trace the daughter cells back to their original parent cell because they will have the marker too

Question 13

normal haemopoiesis is __clonal

Answer 13

poly

Question 14

malignant haemopoiesis is __clonal

Answer 14

mono

Question 15

monoclonal haemopoiesis…..

Answer 15

CANCER UNTIL PROVEN OTHERWISE

Question 16

2 main branches of leukaemia

Answer 16

myeloid

lymphoid

Question 17

if you have a cancer of your primitive lymphoid progenitor cells what is it called?

Answer 17

acute lymphoblastic leukaemia

Question 18

if you have a cancer of your mature lymphoid cells what is it called?

Answer 18

CLL

Question 19

what cancer can involve both blood and lymph nodes?

Answer 19

CLL

Question 20

what is a myeloma?

Answer 20

cancer of plasma cells in the marrow

Question 21

acute/chronic leukaemia is more severe

Answer 21

acute

Question 22

describe features of aggressive cancer on histology

Answer 22

large cells with a big nucleus and nucleolus

rapid proliferation

Question 23

how does bone marrow function differ between acute and chronic leukaemias?

Answer 23

acute has failure of BM function, chronic doesnt

Question 24

chronic myeloid leukaemias tend to affect what cells of the haemopoesis tree

Answer 24

stem cells

Question 25

acute myeloid leukaemias tend to affect what cells of the haemopoesis tree

Answer 25

primitive precursor cells

Question 26

lymphomas tend to occur when problems arise in the maturation of what cell?

Answer 26

B cells

Question 27

excess of blasts in the blood or bone marrow...

Answer 27

acute leukaemia

Question 28

what are lymphoid progenitor cells collectively called?

Answer 28

lymphoblasts

Question 29

most common childhood cancer?

Answer 29

acute lymphoblastic leukaemia?

Question 30

clinical presentation of ALL

Answer 30

outside involvement eg CNS/testis bone pain marrow failure symptoms

Question 31

what are symptoms of marrow failure

Answer 31

anaemia infections bleeding

Question 32

who gets ALL

Answer 32

children

Question 33

who gets AML

Answer 33

elderly >60

Question 34

presentation of AML

Answer 34

``` outside involvement eg CNS/testis bone pain marrow failure symptoms gum infiltration DIC ``` NB VERY SIMILAR TO "ALL"

Question 35

Ix acute leukaemia

Answer 35

1. blood count and film 2. coag screen 3. bone marrow aspirate for film and immunophenotyping

Question 36

describe a blood film of acute leukaemia

Answer 36

presence of auer rods reduction in normal cells presence of abnormal cells eg high nuclear:cytoplasmic ratio

Question 37

morphological characteristic of AML

Answer 37

auer rods

Question 38

what Ix provides a DEFINITIVE diagnosis

Answer 38

immunophenotyping

Question 39

if bone marrow aspiration is contra-indicated/not helpful what could you do?

Answer 39

take a trephine (piece of bone)

Question 40

Tx acute leukaemia

Answer 40

chemo

Question 41

chemo is inserted via what line in leukaemia?

Answer 41

hickman line

Question 42

complications of marrow suppression?

Answer 42

anaemia neutropaenia thrombocytopaenia

Question 43

neutropenic patients are at risk of sepsis from what organisms (state the most and 2nd most likely)

Answer 43

1. gram NEGATIVE bacteria | 2. fungi

Question 44

what drug used in leukaemia can cause cardiomyopathy?

Answer 44

anthracyclines

Question 45

what is defined as remission in leukaemia

Answer 45

<5% marrow blasts with recovery of normal haemopoiesis

Question 46

you are more likely to be cured of ALL in childhood/adulthood

Answer 46

childhood