Haem: Interactive Leukaemia Cases Flashcards
What is a mediastinal mass in a child with a high WBC likely to be?
Thymoma
Which type of leukaemia can cause thymoma?
Acute lymphoblastic leukaemia of T cell lineage
What is the main technique used to identify the type of acute leukaemia?
Immunophenotyping
NOTE: cytochemistry is not very good at predicting whether it is an acute lymphoblastic leukaemia or a primitive myeloid leukaemia
What is a bad prognostic feature in leukaemia?
Very high WCC
What feature seen on blood film would suggest that a leukaemia is myeloid in lineage?
- Granules
- Auer rods
Which techniques are used to determine whether cells are lymphoid or myeloid?
- Cytochemistry
- Immunophenotyping
How is a diagnosis of acute promyelocytic leukaemia confirmed?
- Cytogenetic/FISH/molecular genetic analysis
- 15;17 translocation forming the PML:RARA fusion gene
How is acute promyelocytic leukaemia treated?
- Platelets
- Chemotherapy
- All-trans-retinoic acid (ATRA)
What is the prognosis of acute promyelocytic leukaemia?
Complete remission can be achieved
90% 5-year survival
Why might APML cause a short APTT?
There is so much activation of coagulation factors that it accelerates the clotting of the plasma once calcium is added when APTT is being measured
Aside from chronic leukaemia, which other condition must you consider in an elderly patient with anaemia?
Myelodysplastic syndrome
What is a dimorphic blood film?
Presence of hypochromic microcytes and macrocytic cells
What is the main difference between polycythaemia vera and essential thrombocythaemia?
- PV - increase in RBC and platelet count
- ET - isolated raised platelet count
What is the best investigation for diagnosing polycythaemia vera?
Molecular analysis for JAK2 mutation
How is polycythaemia vera treated?
Venesection + hydroxycarbamide
NOTE: venesection alone is NOT sufficient if the patient also has a high platelet count
