30 Questions
What is leukaemia characterized by?
Neoplastic proliferation of white blood cell precursors
What percentage of blasts in the blood and bone marrow characterizes acute leukaemia?
>20%
What is the classification of acute leukaemia based on lineage of blasts?
WHO classification
What is the typical age group affected by Acute Lymphoblastic Leukaemia?
Children under 6 years
What is the percentage of B-cell lineage in Acute Lymphoblastic Leukaemia?
85%
What is the FAB classification of Acute Lymphoblastic Leukaemia based on?
Morphology of blasts
At what age is acute leukemia most commonly diagnosed?
In old age, around 65 years old
What is a common feature of bone marrow failure in acute leukemia?
Anemia
Which of the following is a common site of organ infiltration in acute leukemia?
Liver and spleen
What is a characteristic feature of Acute Myeloid Leukemia (AML) M3?
DIC
What is a common feature of Acute Lymphoblastic Leukemia (ALL) in children?
Cervical lymphadenopathy and mediastinal widening
What is an important step in the diagnosis of acute leukemia?
Analysis of blood and bone marrow
What is the typical Hb level in AML and ALL patients?
4-5 gm%
What is the characteristic feature of AML M3?
Multiple Auer rods (faggot cells)
What is the percentage of myeloblasts in peripheral smear of AML patients?
>20%
What is the treatment for AML M3?
ATRA (All trans retinoic acid)
What is the characteristic feature of AML in peripheral smear?
Normocytic normochromic anaemia
What is the characteristic feature of AML M4 and M5?
Gum hypertrophy
What is characteristic of AML M2 blasts?
Heterogenous blasts, variable cytoplasm, irregular/cleft nucleus, large nucleoli
What is the characteristic of bone marrow in AML?
Cellularity increased, myeloblast predominant (>20%)
Which of the following cytochemical stains is positive in AML?
All of the above
What is the characteristic of L3 blasts in ALL?
Large homogenous blasts, basophilic cytoplasm, round nucleus, prominent nucleoli, cytoplasmic vacuolation
Which of the following immunophenotyping markers is expressed in AML?
CD13
What is the characteristic of bone marrow in ALL?
Cellularity increased, lymphoblast predominant (>20%)
What is the term for cell surface molecules on leukocytes and other cells?
CD-cluster of differentiation
What is the method used to study the immunological types of acute leukemia?
All of the above
What is the chromosomal abnormality associated with AML with favourable prognosis?
inv16
What is the prognosis of Acute Lymphoblastic Leukemia (ALL) in children?
Favourable prognosis
What is the 5-year survival rate of Acute Myeloid Leukemia (AML) in patients over 70 years old?
Around 30%
What is the term for the alteration in the number of chromosomes in a cell, associated with Hyper diploid ALL?
Hyper diploidy
Study Notes
Leukemia
- Leukemia is a group of disorders characterized by the accumulation of malignant white blood cells in the bone marrow and blood.
Acute Leukemia
- Acute leukemia is characterized by >20% blasts in the blood and bone marrow.
- There are two main types: Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL).
Classification of Acute Leukemia
- WHO classification: based on the lineage of blasts (myeloid or lymphoid)
- FAB classification:
- AML: M0-M7
- ALL: L1-L3
AML Classification (FAB)
- M0: Undifferentiated AML
- M1: AML without maturation
- M2: AML with maturation
- M3: Acute promyelocytic leukemia
- M4: Acute myelomonocytic leukemia
- M5: Acute monoblastic leukemia
- M6: Erythroleukemia
- M7: Acute megakaryoblastic leukemia
ALL Classification (FAB)
- L1: Homogenous small blasts
- L2: Heterogenous blasts
- L3: Large homogenous blasts
Clinical Features
- AML:
- Bone marrow failure
- Anemia
- Infections (fever + low WBC)
- Bleeding (Low platelets)
- Organ infiltration (liver, spleen, lymph nodes)
- ALL:
- Bone marrow failure
- Anemia
- Infections (fever + low WBC)
- Bleeding (Low platelets)
- Organ infiltration (liver, spleen, lymph nodes, testes, meninges)
Specific Clinical Features
- AML M3: Bleeding/DIC, Gum hypertrophy
- AML M4, M5: Gum hypertrophy
- ALL: Generalized lymphadenopathy, Meningeal infiltration, Testicular infiltration
Diagnosis of Acute Leukemia
- Analysis of blood (hematological parameters and peripheral blood smear)
- Analysis of bone marrow
- Cytochemical stains
- Immunophenotyping
- Cytogenetic studies
- Molecular studies
Prognosis
- AML: Overall prognosis is better, especially in children
- ALL: Overall prognosis is poor, especially in adults
- Cytogenetic abnormalities can indicate prognosis (e.g., t(15;17) in AML M3 is a favorable prognosis)
Lab Diagnosis
- Hematological parameters:
- Hb low (4-5 gm%)
- MCV and MCH normal
- Total leucocyte count increased and abnormal
- Platelet count decreased
- Peripheral smear:
- AML: Myeloblasts >20%, Auer rods
- ALL: Lymphoblasts >20%
- Bone marrow:
- Cellularity increased
- Myeloblasts or lymphoblasts >20%
- Erythroid elements and megakaryocytes decreased
- Cytochemical stains:
- AML: Myeloperoxidase, Sudan black, Nonspecific esterase
- ALL: Periodic Acid Schiff (PAS)
- Immunophenotyping:
- AML: CD13, CD33, CD117
- ALL: CD10, CD19, CD20, CD22
This quiz covers the definition, classification, and characteristics of acute leukaemia, including AML and ALL. It also explores the aetiopathogenesis, clinical features, and prognosis of these blood disorders.
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