Haem Flashcards
(156 cards)
What is multiple myeloma?
MULTIPLE MYELOMA
Malignancy of plasma cells (mature B lymphocytes)
(second most common leukaemia)
What is the pathophysiology of multiple myeloma?
What is the precursor and how do you tell the difference
MULTIPLE MYELOMA
- Proliferation of plasma cells from same pool (monoclonal)
- These cells normally secrete antibodies (ab count increased)
- Normally IgG
Precursor
- MGUS (monoclonal gamopathy undetermined significance) is the precursor (5% of over 50s)
- often IgG found on routine exam!
- 1% of MGUS patients will get myeloma
- Myleoma is defined when you have >10% plasma cells and END ORGAN DAMAGE
What are the main features myeloma? (5)
MULTIPLE MYELOMA features (CRAB symptoms)
1. Calcium (high) (increased osteoclasts)
• polyuria
• polydipsia
• constipation, N+V
• fatigue and confusion
2. Renal impairment (50%) (light chain AB get stuck)
3. Anemia (90%) (bone marrow infiltration)
4. Bone disease/pain (lytic lesions)
• backache
• pathological fractures
5. Signs of Bone marrow failure
-Low WCC>infection
-Low Hb>anaemia (SOB/pallor)
-Low platelets>bruising/bleeding
What are some other features of myeloma?
Myeloma
Neurological
- parasthesia
- spinal cord compression
- hyperviscosity syndrome due to antibodies (can lead to stroke/siezure/coma)
Non -neuro
- fever
- splenomegally/hepatomegally
- lymphadenopathy
How do you investigate for multiple myeloma? (bedside, bloods, imaging, special)
And what would you find?
Myeloma investigations (look for the antibodies)
Bedside
-Monoclonal detection
• protein/urine electrophoresis> Bence Jones proteins
• SFLC (serum free light chains)
Bloods •Serum electrophoresis • FBC (normocytic normochromic anaemia) • UsEs (↑Urea ↑Creat ↑Ca2+) • Bone profile • LFTs (ALP high in healing fracture • Blood film (Rouleux formation-stacking of RBC) ↑ESR • BETA 2 MICROGLOBIN (prognosis)
Imaging -whole body MRI •lytic lesions •pepper pot skull •vertebral collapse/fractures
Special tests: bone marrow
-aspirate
What is the treatment of myeloma symptoms?
Treatment of myeloma
Chemotherapy followed by autologous transplant if young and not comorbid
MPT (Melphalan + Prednisolone + Thalidomide) or Lenalidomide + low-dose dexamethasone for those unsuitable for transplant
Hypercalceamia
-IV fluids, bisphosphonates
Bones
- exclude SC compression (complication)
- bisphosphonates to help ↓fractures ↓bone pain ↓Ca2+
Renal
-Fluids and follow AKI guidelines
Anemia
-RBC transfusion + EPO
Infections
-Abx (as appropriate) and regular IV Ig infusions if necessary
What is the treatment for myeloma itself? (3 stages)
Myeloma
INDUCTION
•3 drug chemo combo and steroids to induce remission
MAINTANANCE
- on meds until relapse
- autologous stem cell transplant good for longer remission (obliterate their own BM and save stem cells)
RELAPSE
- almost all patients
- continue or change treatment
**Monitor FBC, creat, Ca2+ serum/urine EP every 2-3 months
Complications of myeloma? (4)
What are the treatments?
Complications of myeloma
-hypercalceamia (IV fluids, bisphosphonates)
-SC compression (MRI and 16mg dex)
-hyperviscosity syndrome (plasmapheresis to remove light chains)
•reduced cognition/disturbed vision/bleeding
-AKI (give fluids, dialysis may be required)
Acute lymphoblastic leukaemia (ALL)
- who normally gets it?
- why do they get it?
Acute lymphoblastic leukaemia (ALL)
Who
-Always“Little people” (most common malignancy affecting children (peak 2-5 yo)
-If adults get it its an awful prognosis
Why
-both AML and ALL can progress from CML
Acute lymphoblastic leukaemia (ALL)
-What are 2 diagnostic investigations? (what would you see)
Acute lymphoblastic leukaemia (ALL)
BLOOD FILM
>20% lymphoBLAST cells on bone marrow (if less than 20% it is just mylodysplastic disorder)
TDT staining (positive)
What is the treatment for Acute lymphoblastic leukaemia)(ALL)
Acute lymphoblastic leukaemia (ALL)
-Imatinib (will relapse)
Who gets Acute myeloid leukaemia (AML)?
How do you get it?
AML=”Always Middle age”/Elderly
Who: incidence increases with age
Why: both AML and ALL can progress from CML
Acute myeloid leukaemia (AML)
-What is the diagnostic finding?
Acute myeloid leukaemia (AML)
-Auer rods, Auer rods, Auer rods!
(not always present but diagnostic)
*also see Myeloidblasts
What are the 2 types of AML and how do they present?
- M3
- M5
Acute myeloid leukaemia (AML)
- M3 (acute PROMYELOCITIC leukaemia)
- medical emergency
- presents with DIC and heamorrage
- t15:17 translocation - M5 (acute monocytic)
- gum infiltration!!
- lymphadenopathy and hepatosplenomegaly
What bloods would you expect from AML and ALL?
AML/ALL bloods present with bone marrow failure (↑lymphoid blasts infiltration)
↓Hb, ↓Plt ↓Neut,↑WBC (poor prognosis)
What is the presentation of AML and ALL?
AML/ALL present with rapid onset bone marrow failure:
ANEMIA
-sob/pallor/lethargy
THROMBOCYTOPENIA
-bleeding/bruising
NEUTROPENIA
-recurrent infections
Systemic
- weight loss
- fever
- malaise
- bone pain (BM failure)
- splenomegally (spleen trying to eat all of extra cells)
ALL vs AML?
- who?
- diagnostic?
- involvement?
ALL children, AML older age
ALL >20% lymphoidBLASTS, AML Auer rods
ALL brain involvement, AML gum involvement (mono M3)
Complication of ALL/AML?
How does it present?
Tumour lysis syndrome
- can happen spontaneously or in response to treatment
- can lead to AKI, can cause visual disturbances (contents pools in eyes)
Presentation: N+V, muscle cramps, confusion
What are the blood findings in tumour lysis syndrome?
Tumour lysis syndrome
- HIGH uric acid
- HIGH phosphate
- HIGH potassium
- LOW calcium
What is the treatment of Tumour lysis syndrome?
Treatment of tumour lysis syndrome:
- hydrate
- treat AKI
- Rasburicase to lower uric acid levels
Translocation for AML?
Translocation for CML?
AML: t15:17
CML: t9:22 Philadelphia chromosome
Who gets chronic lymphocytic leukaemia? (CLL)?
How common is it?
- CLL is a disease of the elderly (opposite of ALL)
- CLL is most common leukaemia
What cells are affected in CLL and what is a diagnostic finding?
chronic lymphocytic leukaemia? (CLL)
- Almost always B Lymphocytes (99%)
- SMUDGE/SMEAR cells are diagnostic (crushed little lymphocytes)
What would you see on bloods for CLL?
Chronic lymphocytic leukaemia? (CLL)
- Bloods: ↑lymphocytes (normally Hb/platelets normal)
- Normally an incidental finding, can cause ITP (mild bleeding and GP checkup)