Leukaemia

Question 1

What are the four types of leukaemia?

Answer 1

Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)
Chronic myeloid leukaemia (CML)
Chronic lymphocytic leukaemia (CLL)

Question 2

How quickly growing are the 4 types?

Answer 2

• Acute = rapid growing
• Chronic = slow growing

Question 3

What is the common presenting age for leukaemia?

Answer 3

60-70 except
ALL = children <5 yrs

Question 4

What is the pathophysiology for leukaemia?

Answer 4

Genetic mutation of one precursor in bone marrow
Excessive production of single WBC
Can result in pancytopenia

Question 5

Presentation for leukaemia?

Answer 5

• non-specific:
  
  • Fatigue
  • Fever
  • Pallor due to anaemia
  • Petechiae or bruising due to thrombocytopenia
    
    • non-blanching regions; <3cm caused by burst capillaries
  • Abnormal bleeding
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Failure to thrive (children)

Question 6

Investigations for leukaemia?

Answer 6

FBC
Blood film
LDH
Bone marrow biopsy
Lymph node biopsies
Immunophenotying

Question 7

Describe acute lymphoblastic leukaemia ( ALL)?

Answer 7

• acute excessive B-lymphocyte accumulation
• affects children <5yrs and older adults
• common with Down’s syndrome
• lymphadenompathy or hepatosplenomegaly

Question 8

Describe chronic lymphocytic leukaemia (CLL)?

Answer 8

Slow proliferation of B lymphocyte
Incidental finding on lymphocytosis on FBC
Over 60
Asymptomatic

Question 9

How can CLL present?

Answer 9

Over 60
Can present with infections, anaemia, weight loss, bleeding, lymphadenopathy, splenomegaly

Question 10

What can CLL develop into?

Answer 10

High grade B cell lymphoma (Ritchter’s transformation)

Question 11

What kind of anaemia can CLL cause?

Answer 11

Warm haemolytic anaemia

Question 12

How to diagnose CLL?

Answer 12

Smear/smudge cells on blood film
Immunophenotyping

Question 13

Treatment for CLL?

Answer 13

Often watch and wait when asymptomatic
Symptomatic - treat with monoclonal antibody’s and chemo (rituximab + fludarabine +cyclophosphamide)

B. Ell signalling inhibitors (iburtinib, venetoclax)

Question 14

Describe the phases CML?

Answer 14

Three phases (chronic, accelerated, blast)
Chronic = asymptomatic, incidental high WCC
accelerated = symptomatic, anaemia, thrombocytopenia, immunodeficiency
Blast = severe symptoms, pancytopenia, often fatal

Question 15

Cause of CML?

Answer 15

Philadelphia chromosome (9 and 22 translocation)
Tyrosine kinase enzyme

Question 16

Symptoms of CML?

Answer 16

Anaemia
Splenomegaly
B symptoms (weight loss, night sweats, early satiety)

Question 17

How to diagnose CML?

Answer 17

Neutrophilia and granulocyte precursors
Bone marrow (excess myeloid cells)

Question 18

Treatment for CML?

Answer 18

Tyrosine kinase inhibitor (imatinib)

Question 19

Describe AML?

Answer 19

Often middle age
Myeloid cell line

Question 20

Cause of AML?

Answer 20

Arise form myeloproliferative disorders (polycyhemia ruby vera, myelofibrosis , CML, essential thrombocythemia)

V short history

Question 21

Diagnosis of AML?

Answer 21

Blood film (Auer rods in blast cells)
Blast cells >20%
Immunophenotyping

Question 22

Treatment for AML?

Answer 22

Chemo (TK inhibitors)
Monoclonal antibodies
Radiotherapy
Bone marrow transplant
Surgery

Question 23

Complications of AML?

Answer 23

Develop into acute promyelocyctic leukaemia subtype
Associated with DIC