Leukaemia

Question 1

what antigen is expressed by mature red cells

Answer 1

glycophorin A

Question 2

What enzyme is expressed by mature neutrophils

Answer 2

myeloperoxidase

Question 3

what investigation do we use to look at antigens expressed on cells

Answer 3

immunophenotyping

Question 4

what do neutrophils look like under a microscope

Answer 4

segmented nuclei, blue granules

Question 5

what protein is expressed by all stem cells

Answer 5

CD34

Question 6

what are the two types of leukaemia

Answer 6

lymphoid

myeloid

Question 7

normal haemopoiesis is monoclonal/polyclonal

Answer 7

polyclonal

Question 8

abnormal haemopoiesis is monoclonal/polyclonal

Answer 8

monoclonal

Question 9

what causes haematological malignancies

Answer 9

genetic mutations (inherited or acquired)
driver mutations/background passenger mutations

Question 10

what developmental stage of haemopoiesis do acute leukaemia’s affect

Answer 10

precursors

Question 11

what type of cells do chronic leukaemias affect

Answer 11

mature cells

Question 12

what types of haematological malignancies are more aggressive

Answer 12

acute leukaemias

high grade lymphomas

Question 13

presentation of acute leukaemias

Answer 13

marrow failure - anaemia, infections, bleeding

infiltration - hepatosplenomegaly, lymphadenopathy

Question 14

features pointing towards acute lymphoblastic leukaemia

Answer 14

children

CNS involvement

Question 15

features pointing towards acute myeloid leukaemia

Answer 15

> 60 years
gum infiltrates (monocytes)
less CNS involvement

Question 16

common infections affecting those with acute leukaemias

Answer 16

bacterial septicaemia 
zoster
CMV
measles 
candidiasis 
pneumocystis pneumonia 
fungal

Question 17

what does acute lymphoblastic leukaemia affect

Answer 17

B and T cell precursors - prevents maturation and differentiation producing immature blast cells

Question 18

what does acute myeloid leukaemia affect

Answer 18

myeloid cell precursors - they proliferate but do not mature

Question 19

what is a protein produced by immature lymphocytes and is a marker of ALL

Answer 19

TdT

Question 20

what are histological features of acute leukaemia

Answer 20

large cells
high nuclear-cytoplasmic ration
prominent nucleoli
rapid proliferation

Question 21

what are auer rods

Answer 21

pin shaped bodies seen in cytoplasm of myeloblasts in AML

Question 22

presentation of chronic myeloid leukaemia

Answer 22

decreased weight 
tiredness
fever
sweats
gout - purine breakdown
bleeding 
abdominal discomfort (splenomegaly)

Question 23

presentation of chronic lymphocytic leukaemia

Answer 23

may be asymptomatic
weight loss and night sweats if severe
enlarged rubbery non-tender lymph nodes
hepatosplenomegaly

Question 24

first line test in leukaemia

Answer 24

blood count - high WCC
increased myeloid cells in CML (neutrophils, basophils, eosinophils etc)
high lymphocytes in CLL

blood film - look for blast cells, large cells, big nuclei, auer rod (AML)

Question 25

diagnostic test in acute leukaemia

Answer 25

bone marrow biopsy - immunophenotyping to differentiate between myeloid and lymphoid

Question 26

other investigations performed in ALL

Answer 26

CXR and CT Abdo - mediastinal and abdominal lymphadenopathy lumbar puncture - CNS involvement

Question 27

treatment of ALL

Answer 27

2-3 years multi-agent chemotherapy

Question 28

treatment of AML

Answer 28

2-4 cycles of chemotherapy | 5-10 days treatment followed by 2-4 weeks recovery

Question 29

what are the 4 phases of ALL chemotherapy

Answer 29

induction consolidation intensification maintenance

Question 30

supportive treatment in ALL

Answer 30

blood/platelet transfusion IV fluids allopurinol (prevents tumour lysis syndrome) Hickman line for IV access

Question 31

biggest risk/complication of leukaemia and its treatment

Answer 31

infection - especially susceptible to fungal infections (take antifungal medication - itraconazole)

Question 32

management of infection in leukaemia

Answer 32

immediately start IV broad spectrum antibiotics - do not wait for culture results

Question 33

side effects of chemotherapy

Answer 33

``` nausea/vomiting hair loss liver/renal dysfunction tumour lysis syndrome (will occur during first course) infection fertility loss cardiomyopathy ```

Question 34

what genetic mutation is seen in >80% of those with CML

Answer 34

Philadelphia chromosome - translocation between chromosome 9 and 22 which affects tyrosine kinae activity (oncogene)

Question 35

treatment for CML

Answer 35

imatinib - tyrosine kinase inhibitor

Question 36

imatinib side effects

Answer 36

``` nausea cramps oedema rash headache arthralgia ```