Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Cancer Care > Leukaemias > Flashcards

Leukaemias Flashcards

1
Q

A 3yo girl presents with a 10/7 history of fatigue, malaise and easy bruising. O/E you note an enlarged spleen + liver as well as multiple bruises + petechiae.

What is the likely diagnosis and how would you investigate?

A

ALL

Bloods

  • FBC: anaemia, thrombocytopaenia, neutropenia, high or low WCC
  • peripheral blood film: blasts
  • coagulation screen: high risk of DIC
  • U+Es, LFTs, LDH

BMAT: BM blasts 25% or more
- also send for immunophenotyping (determine lineage e.g. AML vs ALL) + cytogenetic analysis

Other

  • LP: ?CNS disease
  • CXR: ?mediastinal mass typical of T cell disease
  • abdo. USS: ?intra-abdominal adenopathy or renal infiltration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the supportive + specific management of a patient newly diagnosed with ALL.

A

Supportive:

  1. blood or platelet transfusion: if cytopaenic
  2. hydration + allopurinol (start 12hrs before chemo) OR rasburicase if high risk of TLS
  3. CO-TRIMOXAZOLE (2-3 consecutive days weekly): for P. jirovecci prophylaxis

Specific:
1. induction combination chemo (1/12) to include pred/dex
+/- intrathecal chemo e.g. METHOTREXATE if CNS disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A 3yo child has been diagnosed with ALL (no CNS disease) and received induction combination chemo for 1/12. What will follow up treatment involve?

A
  1. consolidation: systemic chemo + intrathecal chemo

2. maintenance: e.g. daily oral mercaptopurine for 2 (F) or 3 (M) yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What test should be performed before prescribing mercaptopurine?

A

TPMT activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the haematological causes of hepatosplenomegaly?

A
  1. leukaemias: AML, CML, ALL, CLL
  2. lymphomas
  3. myelofibrosis
  4. myeloproliferative disease e.g. essential thrombocytopaenia, polycythaemia
  5. haemolytic anaemias e.g. thalassaemia, sickle cell, spherocytosis, G6PD deficiency, pyruvate kinase deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A 36yo woman presents with a 2/52 Hx of fatigue, palpitations and bruising.
What would a peripheral blood film show if the diagnosis is AML?

A

blasts with Auer rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Suggest risk factors for the development of AML.

A
  1. previous chemo
  2. radiation exposure inc. radiotherapy
  3. haematological dyspoiesis e.g. MDS, aplastic anaemia and myeloproliferative disorders
  4. genetic factors
  5. age >65yrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A patient who has been diagnosed with AML has a WCC of 128,000 cells/uL. How would you treat this hyperleukocytosis?

A

HYDROXYCARBAMIDE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which mutation is characteristic of CML?

A

T(9;22) translocation (Philadelphia chromosome) causing BCR-ABL fusion - constitutively active tyrosine kinase (oncogene)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which signs/symptoms may be present in a patient with AML?

A
  • Sx of anaemia e.g. lethargy
  • Sx of thrombocytopaenia e.g. bruising, bleeding
  • weight loss + night sweats
  • splenomegaly (may be marked) causing abdo. discomfort/fullness
  • +/- hepatomegaly or lymphadenopathy
  • hyperviscosity (due to leucocytosis) e.g. visual disturbances (due to retinal haemorrhages), confusion, cerebrovascular accident, priapism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A 56yo gentleman presents with fatigue, weight loss + bruising for the past 2/12. There is marked splenomegaly on examination and you suspect CML. How will you investigate and what will these show?

A

Bloods

  • FBC: raised WCC, anaemia, +/- thrombocytopaenia/cytosis
  • peripheral blood smear: raised granulocytes (all stages of dev.), >20% basophils, >20% eosinophils
  • U+Es: +/- raised urate
  • LDH: raised

BMAT:

  • aspirate: raised BM blasts
  • trephine: hypercellular marrow, raised myeloid + progenitor cells
  • cytogenetic analysis: t(9;22)
  • qRT-PCR: quantitative detection of BCR-ABL fusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A 56yo gentleman is diagnosed with chronic phase AML.

What is 1st line treatment?

A

TKIs: IMATINIB (v. good cytogenetic response) - inhibits BCR-ABL tyrosine kinase and inhibits proliferation/induces apoptosis of AML cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A 78yo asymptomatic man present with an incidental finding of a lymphocytosis on a recent blood test.

You suspect CLL. How would you confirm diagnosis?

A
  • FBC + differential: raised WCC with lymphocytes
  • peripheral blood smear: smudge cells
  • peripheral blood flow cytometry: typical CLL cell surface markers
  • peripheral blood FISH: to determine prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the management options for CLL?

A
  1. watch + wait: if asymptomatic with no indications for Tx
  2. FCR chemotherapy: if favourable cytogenetics + good performance status
  3. BCR inhibitors e.g. IBRUTINIB + RITUXIMAB: if unfavourable cytogenetics

Indications for immediate Tx include: anaemia or thrombocytopaenia, symptomatic, rapidly progressive disease (<6/12 lymphocyte doubling time, rapidly enlarging lymph nodes or spleen, AIHA or ITP refractory to immunosuppresive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Suggest possible complications of CLL.

A
  1. Richter’s transformation: transformation to high-grade lymphoma
  2. hypogammaglobulinaemia with higher risk of infection
  3. warm autoimmune haemolytic anaemia (10-15%)
  4. anaemia or thrombocytopaenia (poor prognosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is your differential for lymphocytosis?

A
  1. infection e.g. EBV, CMV, TB, hepatitis
  2. smoking
  3. post-splenectomy
  4. CLL
  5. ALL
  6. lymphoma (leukaemic phase)
17
Q

What is myelodysplastic syndrome?

A

Haematopoietic stem cell clonal cytogenetic abnormality causing dysplastic haematopoiesis resulting in:

  • 1+ cytopenias
  • BM dysplasia with <20% blast cells
  • risk of AML development (1/3)
18
Q

A 73 yo man presents with an incidental finding of anaemia + thrombocytopaenia (no bleeding). You suspect myelodysplastic syndrome. How will you investigate?

A

Bloods

  • FBC + differential: 1+ cytopenia
  • reticulocyte count: inappropriately normal (if anaemia) or low
  • folate + B12: exclude deficiency as cause of anaemia
  • iron studies: exclude deficiency as cause of anaemia
  • HIV testing: exclude as cause of anaemia

BMAT

  • aspiration: single or multilineage dysplasia, BM blasts <20%
  • trephine: hypercellular marrow
  • cytogenetic analysis: chromosomal abnormalities characteristic of MDS
19
Q

What are the management option for a patient with myelodysplastic syndrome?

A

If acute high risk disease with suitable donor + good general health: allogeneic HSCT

If asymptomatic: watch + wait, regular FBC

Symptomatic cytopaenia(s) with chromo. 5q31 deletion:

  • LENALIDOMIDE (immunomodulatory agent)
  • RBC or platelet transfusions

Symptomatic cytopaenia(s) without chromo. 5q31 deletion:

  • G-CSF (e.g. filgrastim) or EPO
  • RBC or platelet transfusions

Year 4 - Cancer Care (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions