Flashcards in Leukaemia Deck (29)
What is leukaemia?
Cancer of haematopoietic cells usually associated with increased numbers of white blood cells in the bone marrow or blood.
What cells are implicated in ALL (acute lymphoblastic leukaemia)?
lymphoid progenitor cells
What cells are implicated in CLL (chronic lymphocytic leukaemia)?
Naive B cells
What cells are implicated in AML (acute myeloid leukaemia)?
Myeloid progenitor cells
What cells are implicated in CML (chronic myeloid leukaemia)?
What cells are implicated in myeloproliferative disorders?
Neutrophils, eosinophils, basophils, monocytes, platelets and red cells
What cells are implicated in lymphomas?
T cells and B cells
What cells are implicated in myelomas?
Outline how acute leukaemia presents
- >20% blast cells in bone marrow/blood
- Presentation: signs of bone marrow failure (anaemia, tiredness, SOB, infections, leucostasis)
What is the most common childhood cancer?
ALL (peak incidence is 2-4 years old)
Outline acute lymphoblastic leukaemia (ALL)
>Malignant disease of undifferentiated lymphoblasts
>Most common childhood cancer (with peak incidence 2-4 years).
>Presentation: general lethargy, bone pain and anorexia. Bone marrow failure may present as anaemia, neutropenia (with or without infection), thrombocytopenia (with or without bleeding), lymphadenopathy, and there may be abdominal organomegaly.
Outline acute myeloid leukaemia (AML)
This is a malignant transformation of myeloid precursor cells at a very early stage of their development. This condition is increasingly frequent in older people.
What blood results may indicate leukaemia?
Low platelets, anaemia, elevated WCC (in acute leukaemia)
What cytogenetics are associated with ALL?
Hyperdiploidy is common e.g. 51-65 chromosomes being present
What may be seen in a blood film that indicates AML?
Auer rods may be seen in AML, these are elongated structures of granules
How does chronic leukaemia tend to present?
Weight loss, tiredness, night sweats, splenomegaly, anaemia
What cytogenetics are heavily implicated in CML?
Philadelphia chromosome is present (recipricol translation of chromosomes 9 and 22 which cretes a bcr-abl fusion gene leading to uncontrolled tyrosine kinase activity, which means uncontrolled phosphorylation) there are increased granulocytes of all stages of maturation, with plenty of eosinophils and basophils
What is the 'philadelphia chromosome'?
Recipricol translation of chromosomes 9 and 22 which cretes a bcr-abl fusion gene leading to uncontrolled tyrosine kinase activity, which means uncontrolled phosphorylation ==> uncontrolled proliferation of granulocytes --> associated with CML
What are the phases of CML disease?
> Chronic phase = 3-5 years
> Accelerated phase = 3-6 months
> Blast crisis = 3 months (followed by death)
What is the treatment of CML?
Imatinib (small molecule inhibitor of bcr-abl, due to philadelphia chromosome)
What is CLL?
Proliferation of small mature B lymphocytes in the bone marrow and peripheral blood. Presentation is ordinarily around 65-70 years of age with most patients being asymptomatic and diagnosed on the basis of a routine blood test.
How might CLL present in bloods?
Normochromic, normocytic anaemia, reduced platelets, lots of lymphocytes with smear cells
How is CLL treated/managed?
May require observation, but indications for treatment include: autoimmune haemolytic anaemia, ITP, systemic systems, bone marrow failure and organomegaly
What is myelodysplastic syndrome (MDS)?
Where there is ineffective production of blood cells usually in the elderly but this can transform into acute myeloid leukaemia.
Outline the process of bone marrow donation
A patient or donor is given G-CSF subcutaneously for 4 days to mobilise CD34+ stem cells into the peripheral blood, which can then be collected on day 5 by leucapheresis
Outline the blood results for ALL
Normocytic anaemia, low platelets, high WCC (due to lots of blasts)
Outline the blood results for CLL
Normocytic anaemia, low platelets, high lymphocytes and low neutrophil count
Outline the blood results for AML
Macrocytic anaemia, low platelets, high WCC (increase blasts)