Haematological Malignancies Flashcards
(24 cards)
What should a high total protein and low albumin make you think of?
Myeloma
Investigate!
At the very least do protein electrophoresis
What is protein electrophoresis?
Separates monoclonal proteins produced by cancerous plasma cells
Can also separate them into heavy and light chains to identify the monoclonal protein via immunofixation
What are the biochemical markers of myeloma?
Serum monoclonal protein of 3g/dl or more
Bone marrow plasma cell burden of 10% or more
Symptoms - endorgan damage:
- Anaemia
- Renal failure
- Hypercalcaemia
What can you find in the blood in myeloma?
Rouleax formation - red cells stacked on top of each other (due to increased immunoglobulins with + electrical charge)
Plasma cells - eccentric nucleus with blue grey cytoplasms
What are the complications of myeloma?
Bone lytic lesions
Confusion
- Renal failure
- Hypercalcaemia
- Hyperviscosity
- Meningitis
- Septicaemia
- Intracranial plasmacythoma
Spinal cord compression
- Vertebral fracture
- Extracurricular cord compression by plasmacytoma
- presents with worsening back pain, decreased muscle power and tone in legs, incontinence
What is the work-up for spinal compression in myeloma?
Diagnostic tests:
- Spinal x ray
- MRI / CT myelogram
Management:
- Radiation
- Decompression surgery
- Rehab + support
What are the causes of acute renal failure in myeloma?
Dehydration
Hypercalcaemia
Nephrotoxic drugs
Radiographic contrast
Infection
Disease progression
How does one manage acute renal failure in myeloma?
Adequate hydration (input-output monitoring, fluid)
Treat cause
Diuretics
Adjust medication according to renal function
Renal consult
Dialysis
What is the significance of hypercalcaemia?
It indicates active/progressive disease
Associated with:
- Treatable/curable malignancy in myeloma/lymphoma/lymphoblastic leukaemia
- Advanced disease/ bone metastasis/ paraneoplastic syndrome in solid tumours
How is hypercalcaemia managed?
Emergency if acute:
Hydration (with saline)
Monitor input/output
IV steroids
Bisphosphonates - can give hypocalcaemia - reduce dose in renal failure
Furosemide
Chronic hypercalcaemia can be asymptomatic - not an emergency
What is the treatment for myeloma?
Qualifies for stem cell transplant:
- high dose steroids
- chemo
- biological agents (e.g., Thalidomide)
- autologous stem cell transplant
Does not qualify:
- low dose steroids
- chemo
- biological agents
Seldom curable - can live >10 years
What do lymphoblasts look like?
Picture
What are the symptoms of leukaemia?
Non-specific:
- Tiredness
- Generalised body pain
- Fever
- Sore throat etc.
More specific:
- Anaemia
- Bleeding tendency
- Lymphadenopathy
- Splenomegaly
- Systemic infection
- Gum hypertrophy
- Severe bone pain (lytic lesions and fractures)
- CNS findings
- Testicular mass
- Skin rash/infiltrates
What does the FBC look like in acute leukaemia?
Anaemia
Thrombocytopaenia
WCC - <1.0 - >100
Neutropaenia
What are the potential complications of acute leukaemia?
Cytopenia
DIC
Infection
Electrolyte abnormalities
Hyperleukocytosis - Leukostasis
Superior VC syndrome
Spontaneous tumour lysis
Perianal sepsis
What is hyperleukocytosis - leukostasis?
WCC > 100
At risk of leukostasis - risk of occlusion of blood vessels by WBCs
- Pulmonary infiltrates with respiratory failure
- Brain bleeds (made worse if platelets are low)
Avoid red cell transfusion if WCC >100
What do the blasts that cause leukostasis look like?
Picture
What is perianal sepsis?
Perianal pain and swelling
Neutropenic - no abcess forms - no drainage
Treat with GN and anaerobic cover antibiotics
How is acute promyelocytic leukaemia handled?
Emergency - bleeding cause by DIC
Very good prognosis - 80% cure rate
Needs blood products
What does APL look like on a smear?
Picture
What are the types of lymphoma?
Mostly B-cell lymphomas (can be T-cell)
- Diffuse large B-cell lymphoma
- Burkitt lymphoma
- Plasmablastic lymphoma
Rapid growing!
Risk of:
- Airway obstruction
- Spinal cord compression
- Hydronephrpsis and anuria
What does diffuse large B cell lymphoma look like?
Picture
What does Burkitt lymphoma look like?
Picture
What does plasmablastic lymphoma look like?
Picture
