Intro to leukaemia

Question 2

What are the classifications of leukaemia?

Question 3

Chronic myeloid leukaemia

Answer 3

Clonal haemopoietic stem cell disorder
Philadephia chromosome
Excessive production of granulocytes (mature)

Question 4

Acute leukaemia

Answer 4

Primitive looking cell
Monotonous
High nucleus:cytoplasmic ratio

Defined as an excess of ‘blasts’ in either the peripheral blood or bone marrow

Question 5

Acute lymphoblastic leukaemia

Answer 5

Can involve lymph nodes occasionally
Excess of lymphoblasts

Clinical presentation: due to marrow failure (anaemia, infections, bleeding)

Question 6

Acute myeloid leukaemia

Answer 6

malignant disease of primitive myeloid cells (an excess of myeloblasts)

More common in older age group

May be ‘de novo’ or secondary

Presentation can be similar to ALL

Some subgroups might have coagulation defect like DIC/Gum infiltration

Question 7

What are the investigations for acute leukaemia?

Answer 7

1. Morphology (blood film)
   Auer Rod
2. Coagulation screen, particularly for ruling out DIC
3. Bone marrow aspirate

Immunophenotyping is required for definitive diagnosis

Question 8

How to treat acute leukaemia?

Answer 8

Supportive care - replacing blood cells, giving antibiotics (it is not worth neutrophil transfusion due to their short half-life)

Question 9

What is Hickman-line?

Answer 9

Central IV access to junction between superior vena cava and right atrium

Answer 10

Gram -ve bacteria is particularly dangerous in case of marrow suppression

Prolonged neutropenia also makes patient susceptible to fungal infection

Question 11

What is the infectious aspect of anti-leukaemic treatment complications?

Question 12

Chronic lymphocytic leukaemia

Answer 12

A clonal lymphoproliferative disorder of the mature B lymphoid compartment

• Median age of diagnosis is 72 yo
• Slow pace of development
• Often no clinical features, or very non-specific symptoms (night sweats, fever, fatigue, weight loss)
• In a small number of patients, can transform to a different lymphoma
• related to spleen enlargement/bone marrow infiltration
• Immunocompromised;
• Autoimmune cytopenia

Question 13

What are the three possible causes of cytopaenia in CLL?

Question 14

CLL morphology characteristic

Answer 14

Smear cell

Question 15

CLL diagnostic workup

Question 16

How to manage CLL patients that transformed into a high grade type?

Question 17

What are the particular side effect profiles of targeted therapies used in CLL?