Haemolytic Crash Course Flashcards
(46 cards)
Which of these is the most concerning for an acute leukaemia:
A. Neutrophil count of 12
B. 10cm splenomegaly
C. Microcytic anaemia
D. Blast cells present on blood film examination
E. Cervical lymphadenopathy
D. Blast cells present on blood film examination
What can cause a high platelet count? (5)
- Acute infection
- Chronic inflammation
- Malignancy (5-10%)
- Essential thrombocytopenia
- Polycythaemia rubra vera
Patients who are well with no inflammation or infection should be investigated
Which of these blood differentials is most in keeping with CML?
1
Chronic leukaemias always have a high WCC (excluding 3 + 4)
With CML would expect a high neutrophil count (excluding 2)
High platelet, eosinophil + basophil count is in keeping with CML
Rank these in order of Ann-Arbor staging (top stage 1- bottom stage 4)
A. Cervical lymphadenopathy + BM infiltration
B. Mediastinal + axillary lymphadenopathy
C. Inguinal + Cervical lymphadenopathy
D. A single enlarged lymph node in the axilla
D. Single enlarged LN in axilla
B. Mediastinal + axillary lymphadenopathy
C. Inguinal + Cervical lymphadenopathy
A. Cervical lymphadenopathy + BM infiltration
A patient with newly diagnosed Burkitt Lymphoma has these blood results 6h after chemotherapy
Creatinine 200 (baseline 90) Urea 14.4 (baseline 6) K+ 7.1 (3.5-5.5) Na+ 140 (135-145) Ca2+ 1.81 (2.2-2.6) Phosphate 1-1.6) Uric acid 800 (<400) What is the diagnosis? What is the treatment?
Diagnosis: Tumour lysis syndrome
Tx: Resburicase (depletes uric acid levels), treat K+, renal replacement therapy
Use Allopurinol to prevent this or Resburicase in high risk patient
What investigations are needed for a patient with an IgG lambda paraprotein of 25g/l discovered on a routine blood test?
Anyone with a IgA paraprotein >10 or IgG paraprotein >15 get referred to haematology clinic
Imaging to look for bone lesions + BM biopsy
55M with no PMH presents with fatigue to his GP. Bloods show
WCC 7 Hb 90 MCV 95 Na 140 K 4.0 Creatinine 90 Calcium 2.5 Serum electrophoresis shows an IgG kappa paraprotein of 37g/l Full body MRI shows no lytic lesions BM aspirate shows a clonal population of plasma cells, 15% of marrow cells What is the most likely diagnosis? A. Acute Leukaemia B. Multiple Myeloma C. Smouldering Myeloma D. MGUS E. Waldenstrom’s Macroglobulinaemia
B. Multiple Myeloma
Paraprotein >30 means it can only be multiple myeloma or smouldering myeloma
CRAB Sx: fatigue and Hb of 90 (with no other cause) confirms dx of MM
55M presents with 2/52 hx of fatigue and easy bruising to his GP. Bloods show
WCC 27 Hb 90 Plt 30 Na 140 K 4.0 Creatinine 90 Calcium 2.5 Blood film shows presence of blasts, with 27% blasts in marrow Flow cytometry shows a clonal population of cells expressing CD34, CD19 + TdT Cytogenic analysis shows the presence of t(9;22) What is the most likely diagnosis? A. Acute Myeloid Leukaemia B. Acute Lymphoblastic Leukaemia C. Mixed Phenotype Acute Leukaemia D. Adult T-cell Leukaemia-lymphoma E. Burkitt’s lymphoma
B. Acute lymphoblastiic leukaemia
Any % >20% blasts in BM defines acute leukaemia
CD19: B cell marker
TdT: Lymphoid precursor marker
t(9;22): seen in CML, but also ~1/3 cases of ALL
- 55M presents with 2/52 hx of fatigue and easy bruising to his GP. Bloods showWCC 27Hb 90Plt 30Na 140K 4.0Creatinine 90Calcium 2.5Blood film shows presence of blasts, with 27% blasts in marrowFlow cytometry shows a clonal population of cells expressing CD34, MPO
What is the most likely diagnosis?
A. Acute Myeloid Leukaemia
B. Acute Lymphoblastic Leukaemia
C. Mixed Phenotype Acute Leukaemia
D. Adult T-cell Leukaemia-lymphoma
E. Burkitt’s lymphoma
Acute Myeloid Leukaemia
Auer Rod
MPO: myeloid cell marker
25M presents to GP after 4/52 hx of intermittent fevers + drenching night sweats. Blood results show:
WCC 7 Hb 120 Plt 300 Na 140 K 4.0 Creatinine 90 Calcium 2.5
Examination reveals cervical lymphadenopathy , which is biopsied. On biopsy there are multinucleated cells. What is the diagnosis?
A. Mantle Cell lymphoma B. Disseminated tuberculosis C. Chronic Lymphocytic Leukaemia D. Hodgkin’s Lymphoma E. Burkitt’s Lymphoma
D. Hodgkin’s lymphoma
Reed Sternburg cell on biopsy
- A 50F presents to GP with left sided abdominal pain. Examination reveals palpable splenomegaly. Blood tests:WCC 30Hb 110Platelets 500Neutrophils 20Monocytes 0.7 (<1)
A blood film shows left shifted granulocytes.
Urgent FISH shows presence of BCR-ABL1 fusion gene. What is the most likely diagnosis?
A. Chronic Myeloid Leukaemia B. Chronic Myelomonocytic Leukaemia C. Myelodysplastic syndrome D. Essential Thrombocythaemia E. Myelofibrosis
CML
Left shifted granulocytes and BCR-ABL1 fusion gene
Give 3 clinical manifestations of BM failure
Anaemia: SOB, Chest pain on exertion, fatigue
Thrombocytopenia: easy bruising, petechial rashes, spontaneous bleeding e.g. epistaxis
Neutropenia: frequent or severe infections inc. opportunistic infections
In which type of leukaemias is splenomegaly more common?
LESS common in ACUTE than chronic leukaemias (as takes a long time for spleen to enlarge that much)
Give 5 potential features of AML on presentation
Bone pain
Occassional mild lymphadenopathy
Fevers from disease
Rarer: gum infiltrates, skin
Pancytopenia: May have elevated WCC- but low neutrophil count
In which type of leukaemia is there less burden in the BM?
Chronic
Slower proliferation
(thus less anaemia, thrombocytopenia + neutropenia, but will develop eventually given enough time)
How may chronic leukaemias be differentiated on examination?
CLL: Lymphadenopathy + Splenomegaly
CML: Splenomegaly
How may chronic leukaemias be differentiated on examination?
CLL: Lymphadenopathy + Splenomegaly
CML: Splenomegaly
What is leukostasis? What can this result in? (4)
Haematological emergency
High WCC causes blood to be viscous + end organ damage:
Retinopathy
Pulmonary infiltrates
Bleeding
Thrombosis
What is the treatment for leukostasis?
Leukaphoresis or chemo/ steroids
Give 6 features that may present in a question about ALL
- Often 2-5y
- Hepatosplenomegaly
- Bone pain/ limp
- Fevers
- CNS Sx (up to 10%)
- Testicular swelling (rare but specific)
How would ALL present in an adult?
BM failure
Bone pain, splenomegaly
Lymphadenopathy
What will be seen on a blood test in acute lymphoid leukaemia?
High WCC (but not always)
Anaemia
Thrombocytopenia
Some analysers flag blasts as lymphocytes
What will be seen on blood film in ALL?
High nuclear : cytoplasmic ratio
Lymphoblasts larger than RBCs (normal lymphocytes same size as RBCs)
Blasts often have tails/ blebs of cytoplasm
What can be used to distinguish between ALL and AML?
Immunophenotyping (looking at markers expressed)
