Normal blood film
Donuts Biconcave disc Lymphocytes Neutrophils Platelets ***
Acute leukaemia
Proliferation of primitive precursor cells usually only found in bone marrow
Proliferation without differentiation
What does acute leukaemia do and lead to
Replaces normal bone marrow cells, leads to:
- anaemia: palor and lethargy
- neutropenia: infections -thrombocytopenia: bleeding
- bone pain due to marrow infiltration
Acute leukaemia types
ALL: acute lymphoblastic leukaemia
AML: acute myeloid leukaemia
Chronic leukaemia types
Chronic lymphatic leukaemia (CLL)
Chonic myeloid leukaemia (CML)
Blasts in acute leukamia
Proliferation of balst cells?
**
Acute lymphoblastic leukaemia
Malignant proliferation of lymphoblasts in bone marrow
Acute lymphoblastic leukaemia affects
Mainly children
Acute lymphoblastic leukaemia prognosis
Good: 85% cure rate
-esp girls, age 1-10, low WBC, certain morphology
Poor: adults
Acute lymphoblastic leukaemia treatment
Induction chemotherapy
Consolidation chemotherapy +/- craniospinal irradiation
Maintenance chemotherapy
Bone marrow transplantation only if relapse
goes on for 2 years
Acute myeloid leukaemia
Malignant proliferation of myeloblasts in bone marrow
Acute myeloid leukaemia affects
Mostly adults
Acute myeloid leukaemia prognosis
Poor: 15-50% 5 year survival (depends on subtype)
Most pts relapse
Acute myeloid leukaemia subtype for dentists
M5: gum infiltration in acute monocytic subtype
Acute myeloid leukaemia treatment
Cyclical high dose chemotherapy (induction and consolidation with no maintenance)
Sometimes bone marrow transplantation
Chronic lymphatic leukaemia
Proliferation of mature lymphocytes, usually B cells
Chronic lymphatic leukaemia affects
Commonest leukaemia
Affects elderly >65 years
Chronic lymphatic leukaemia presents with
Anaemia, infections, lymphadenopathy, splenomegaly
Lymphocytosis on blood film
-nucleus is much more packed than earlier one??
Chronic lymphatic leukaemia prognosis
Good
Survival >10 years is norm
Chronic lymphatic leukaemia treatment
Only advanced disease
Chronic myeloid leukaemia
Gradual onset
High white cell count & splenomegaly
Philadelphia chromosome (chromosome translocation of 22 and 15)
BCR-ABL tyrosine kinase
-BCR and ABL oncogenes next to each other
Chronic myeloid leukaemia phases
3: chronic, accelerated, and blast crisis
- diagnosis in chronic form (usually about 3 years)
- acute harder to treat with chemotherapy
Chronic myeloid leukaemia treatment
Imatinib (Glivec)
-blocks abnormal BCR-ABL tyrosine kinase activity
-can result in molecular remission
Allogeneic stem cell transplantation
Myelodysplasia
“Premalignant” condition of haemopoietic precursors
Myelodysplasia affects
Disease of the elderly
Myelodysplasia symptoms
Can be asymptomatic
May present with anaemia, thrombocytopenia, panycytopenia
Myelodysplasia types
Several subtypes
Variable course
Can transform to acute myeloid leukaemia
Myelodysplasia treatment
Supportive care
Bone marrow transplantation in the young
Lymphoma
Hodgkin lymphoma
Non Hodgkin Lymphoma
Hodgkin lymphoma presentation
Painless lymphadenopathy
B symptoms: Sweats, Weight loss, Fever
Hodgkin lymphoma affects
2 peaks 15-35 years and >55
Hodgkin lymphoma prognois
10 year survival 90%
Hodgkin lymphoma types
4 subtypes
Reed-Sternberg cell diagnostic on biopsy
Hodgkin lymphoma treatment
Chemotherapy
Radiotherapy
Stem cell transplantation
Non Hodgkin lymphoma
Indolent or low grade eg follicular lymphoma
Aggressive or high grade eg Diffuse large B cell lymphoma
Aggressive or high grade eg Diffuse large B cell lymphoma
Rapidly progressive
Usually symptomatic
Potentially curable
Aggressive or high grade eg Diffuse large B cell lymphoma treatment
Chemotherapy
Radiotherapy
Transplantation
Indolent or low grade eg follicular lymphoma
Gradual onset, usually advanced at presentation
May be asymptomatic
Incurable, median survival 10years
Indolent or low grade eg follicular lymphoma treatment
Chemotherapy
Radiotherapy
Transplantation
Myeloproliferative disorders
Polycythaemia Rubra Vera (PRV) -red cell proliferation Chronic Myeloid Leukaemia (CML) -white cell proliferation Essential Thrombocythaemia (ET) -platelet proliferation Myelofibrosis -marrow stroma proliferation
Polycythaemia = erythrocytosis
> in circulating red cell concentration
Secondary Polycythaemia = erythrocytosis
Hypoxic: High altitude, lung or cyanotic heart disease
Inappropriate erythropoietin secretion: Renal tumour
Primary Polycythaemia = erythrocytosis
Polycythaemia rubra vera
Pruritus, plethoric facies
Thrombosis
Splenomegaly, hepatomegaly
Treatment of primary polycythaemia = erythrocytosis
Venesction
Aspirin
Myelosuppression
Outcome of polycythaemia = erythrocytosis
Myelofibrosis (15-20%), AML (2-10%)
Secondary Thrombocytosis
Bleeding
Infection
Inflammation
Malignancy
Primary: Essential Thrombocythaemia
Uncontrolled malignant proliferation of megakaryocytes
Platelets >600 persistently
Arterial and venous thrombosis
Bleeding with very high counts eg >1500
Primary: Essential Thrombocythaemia treatment
With aspirin, hydroxycarbamide, anagrelide, interferon
Multiple myeloma
Malignant proliferation of plasma cells in the bone marrow
Plasma cells are terminally differentiated B lymphocytes that produce immunoglobulin
Myeloma has monoclonal immunoglobulin in blood and urine
Symptoms of myeloma
Lytic lesions in bones including skull -pain and pathological fractures Hypercalcaemia due to bone resorption -thirst, polyurea, confusion, constipation Hyperviscocity due to immunoglobulin Renal failure Anaemia Infections *Plasma cells in bone marrow*
Diagnosis of myeloma
Blood and urine tests
X-rays and CT/MRI
Bone marrow
Treatment of myeloma
Chemotherapy
Thalidomide, Bortezomib
Radiation
Stem cell transplantation