Leukaemia (2) Flashcards
What is it?
What is it classified into?
How does Acute differ from Chronic in its pathophysiology?
What does it lead to?
What are its 4 types? What ages are they most common in?
➊ Cancer a specific bone marrow stem cell line, leading to underproduction of certain blood cells
➋ Acute or Chronic, and Myeloid or Lymphoid
➌ * Acute is due to impaired cell differentiation, which results in a large number of malignant precursor cells in the bone marrow
* Chronic is due to excessive proliferation of mature malignant cells, but cell differentiation is unaffected
N.B. Acute = Immature WBCs proliferating. Chronic = Mature WBCs proliferating.
➍ Suppression of the other cell lines, leading to Pancytopenia
➎ ALL CeLLmates have CoMmon AMbititons:
* < 5/> 45 - Acute Lymphoblastic leukaemia (ALL)
* > 55 - Chronic Lymphocytic leukaemia (CeLLmates)
* > 65 - Chronic Myeloid leukaemia (CoMmon)
* > 75 - Acute Myeloid leukaemia (AMbitions)
Acute Lymphoblastic leukaemia (ALL):
What occurs here?
Who is it most common in?
Which congenital condition is it associated with?
How does it present?
What will be seen on a blood film?
➊ Abnormal proliferation of lymphoid progenitor cells, which infiltrate the normal haematopoietic stem cells of the bone marrow as well as other organs
➋ Children < 5 yrs
➌ Down’s syndrome
➍ That of:
• Bone marrow failure - pancytopenic symptoms
• Organ infiltration - bone pain, painless lymphadenopathy, hepatosplenomegaly, ranial nerve palsies (CNS infiltration), painless unilateral testicular enlargement (testicular infiltration)
➎ Blast cells
Chronic Lymphocytic leukaemia (CLL):
What occurs here?
How does it often present?
What will be seen on a blood film?
What can it transform into? What is this process called?
➊ Proliferation of functionally incompetent malignant B cells
➋ Typically asymptomatic, but may present with non-tender lympahenopathy, infections, anaemia, bleeding, weight loss
➌ Smear/Smudge cells - during preparation of the blood film, the aged/fragile cells rupture and leave a smudge
➍ High-grade lymphoma (Richter’s transformation)
Acute Myeloid leukaemia (AML):
What is it associated with?
How does it present?
What will be seen on a blood film?
➊ Myelodysplastic syndromes
➋ That of:
• Bone marrow failure - pancytopenic symptoms
• Organ infiltration - hepatomegaly, splenomegaly, gum hypertrophy
➌ Auer rods
Chronic Myeloid leukaemia (CML):
What are its 3 phases?
How does it present?
What will be seen on blood tests?
What is it usually associated with?
How is it managed?
➊ * Chronic - Often asymptomatic with raised WCC
* Accelerated - Abnormal blast cells make up a lot of the bone marrow and blood cells - More symptomatic as pt develops symptoms of bone marrow failure (pancytopenia)
* Blast - Abnormal blast cells make up even more of the bone marrow and blood cells - Severe symptoms and pancytopenia, which is often fatal
➋ * Massive splenomegaly (>75%)
* Weight loss, fatigue, fever, sweating
➌ Leucocytosis, in particular raised myeloid cells, including neutrophils, monocytes, basophils, and eosinophils
➍ Philadelphia chromosome = BCR-ABLt(9;22) gene translocation
➎ Imatinib (tyrosine kinase inhibitor), with > 80% of pts responding completely to therapy
N.B. ALL is also associated with the Philadelphia chromosome, where it is a poor prognostic marker.
What’s the main complication associated with treating these pts?
→ What occurs here?
→ How does it present?
Tumour Lysis Syndrome
→ Release of Uric acid, Potassium and Phosphate from the cells being destroyed by chemotherapy
→ 2 days after receiving high-dose chemotherapy, presenting with dysuria/oliguria, abdominal pain, or weakness
