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Acute lymphoblastic leukaemia (ALL) (Clinical presentation (Fatigue,…
Acute lymphoblastic
leukaemia (ALL)
Risk factors
Down's syndrome
Irriadiation
Clinical
presentation
Fatigue
Bruising/bleeding
Recurrent infections
Bone pain
Night sweats
Weight loss
Diagnosis
Examination
Abdo exam
Hepatomegaly, splenomegaly, LNs
Genital exam
Orchidomegaly
Neuro exam
CN palsies, meningism
Investigations
Bloods
FBC (low Hb, low Plb, high WCC),
U+E (may be impaired), LFT (may be deranged), clotting,
blood cultures (infection)
Blood film (lymphoblasts)
PCR (MRD)
Biopsy
BM biopsy/aspirate: morphology,
immunotype, cytogenetics
Bedside
Obs (fever)
Weight/height (weight loss)
Imaging
CXR: mediastinal LNs
CT abdo: abdominal LNs
LP
If suspected CNS disease
CSF for cytology
History
PMH
Known medical conditions,
Down syndrome
DH
Meds, allergies
PC/HPC
Fatigue, weight loss, night sweats,
bony pain, brusing/bleeding, infections
FH
Leukaemias/lymphomas,
cancer syndromes
SH
Living arrangements, occupation/school,
smoking, alcohol
Management
Medical
Chemotherapy
Indication: remission, maintenance, CNS prophylaxis
Route: IV (systemic), intrathecal (CNS disease)
E.g. vincristine, danorubicin, prednisolone
SEs: infection, TLS, alopecia, mucositis, N+V
Biologics
Indication: specific marker present
E.g. imatinib, rituximab
IV fluids
Indication: hydration pre-chemo
Allopurinol
Indication: TLS prophylaxis pre-chemo
Surgical
BMT
Indication: young adults in remission
MOA: allogenic or autogenic transplant
SEs: rejection
Conservative
Information, advice, support
MDT care (speciality medic and surgeon,
specialist nurse, psychologists, counsellors)
Monitoring (MRD)
Complications
Infections
Prophylactic abx, antifungals, antivirals
Neutropenic sepsis
Nuetropenic regimen
Tumour lysis syndrome
Treat with allopurinol
Pancytopenia
Red cell/platelet transfusions
DIC
Coagulopathy
Definition
Malignant disorder of
lymphocytes
Epidemiology
Commonest leukaemia in children,
peak 2-5y
Rare in adults
Pathphysiology
Defect
Genetic susceptibility plus environmental trigger
Chromosomal translocation causing B +/or T cell malignancy
Mechanism
Occurs in a primative precursor, with uncontrolled proliferation and minimal mature function
BM failure and infiltration of tissues (commonly CNS)
Prognosis
Good in children, poor in adults