Skip to main content

Haematology summary 17


Chapter 17 in haematology (Acute lymphoblastic leukaemia)summary

-Acute lymphoblastic leukaemia (ALL) is casued by an accumulation of lymphoblasts in the bone marrow. It isthe most common malignant disease of clidhood-75% of cases occur before the age of 6 years. Eighlty-five per cent of cases are of B-cell lineage with the rest being of T-cell lineage.

-The first genetic mutation ocuurs in amy cases in utero, with a secondary genetic event occuring later inclidhood,possibly as a reaction to an infection.

-The clinical presentation is with the features of bone marrow failure (anaemia,infection and bleeding) together with symptoms of tissue infiltration by tumour cells, leading to bone pain or swollen lymph nodes.

-Diagnosis is by examination of blood and bone marrow.important tests include microscopic examination of the tumour cells, immunophenotyping and genetic analysis.

-ALL is subclassified according to the underlying genetic defect and a wide varity of genetic lesions are seen . The number of chromosomes in the tuomour cell has prognostic impotance: hyperdiploid cell have >50 chromosomes and generally have a good prognosis whereas hypodiploid cases (>44 chromosomes)carry a poor prognosis.

-Treatment protocols for ALL are extremely complex and usually have four compoents- remission induction ,intensification ,CNS- directed therapy and maintenance.

-Treatment is risk adjusted to reduce the treatment given to patients with good prognosis.This is based on age ,gender, white cell count and cytogenetics at presenatation.

-Small numbers of tumour cells may sometimes be detected by FACS or molecular analysis even when the blod and bone marrow apear to be clear of leukaemia. This minimal residual disease has prognostic significance and is used in planing therapy.

-If relapse occurs during chemotherapy the outlook is poor but if it happens after years off all treatment the outlook is better. Further chemotheraoy and allogeneic SCT should be cosidered.

-Overall,85% of chlidren can now expect to be cured. The cure rate in adults drops significantly to less than 5% over the age of 70 years.

 

From book: Essentail Haematology A.V.HOFFBRAND,P.A.H.MOSS.6EDITION

Comments

Post a Comment

Popular posts from this blog

Haematology summray 8

Chapter 8 in Haematology (Granulocytes and monocytes) summary -Granulocytes include neutrophils (polymorphs),eosinophils and basophils.They are made in the bone marrow under the control of a variety of growth factors   and have a short lifspan in the blood stream befor entring tissues. -Phagocytes (neutrophils and monocytes) are the   body's main defence against bacterial infection.Neutrophil leucocytosis occurs in bacterial infection and in other types of inflammation.Neutropenia , if severe, predisposes to infection. It may be caused by bone marrow failure, chemotherapy or radiotherapy drugs. -Eosinophilia is most frequently caused by allergic diseases, including skin diseases,parasitic infection or drugs. Ti can be caused by clonacal increase in eosinophils termed chronic eosinophil leukamia or an idiopathic condtion, often associted with tissue damage. -Detects of function of neutrophils and monocytes may affect their chemotaxis, phagocytesis oe killing. ...
Post a Comment
Read more

Haematology summray 9

Chapter 9 in Haematology (White cells: lymphocytes) summary -Lymophcytes are immunologically comptent white cells that are involved in antibody production   (B cells) and with the body's defence against viral infection or other foreign invasion (T cells). -They arise from haemopoietic stem cells in the marrow, T cells being subseqently processed in the thymus. -B cells secrete gammaglobulin antibodies specific for individual antigens.T lymphocytes are further subdivided into helper (CD4 + ) and cytotoxic (CD8 + )cells .They recognise peptides on HLA atigens.Natural killer cells are cytoxic CD8 + cells that kill target cells with low expression of HLA molecules. -The immune response occurs in the germinal centre of lymph nodes and involves B-cell and T-cell proliferation, somatic mutation, selection od cells by recognition of antigen on antigen-presenting cells and formation of plasma cells (which secrete immunoglobulin)or memory B cells. -Immunoglobulins inc...
Post a Comment
Read more

Heamatology summary 12

Chapter 12 in Haematology (Haematoloical malignancy: managment) summary -Progress in the treatment of haemopoietic malignancies has been the result of improvemnets in both supportive therapy and speicific tumour treatments. -Supportive treatments often include : insertion of a central nevous catheter; Appropriate use of red cell and platelet transfusions; Early administration of drugs to traet infection;Otimiziation of the blood coagulation system Drugs to reduce side effects such as nausea or pain;Psychological support. -Gram-positive skin organisms such as staphyloccus are common infections and often colonize central venous catheters. -Gram-Negative bacteria are usually derived from the gut and and can cause severe septicemia. -The use of air filters,handwashing and antibiotics can reduce infection rates . -Neutropenic patients who developa fever should be treated urgently with broad-spectrum antibiotics. -Herpes viruses are a common cause of infection in ...
Post a Comment
Read more