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37 Cards in this Set

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1. Granulocytopenia?
a. A reduction in total circulating leukocytes.
2. Lymphoblast?
a. A large, primitive, undifferentiated precursor cell not normally seen in the peripheral circulation.
3. Pancytopenia?
a. A reduction in circulating erythrocytes, leukocytes, and platelets.
4. Most common childhood cancer?
a. Leukemia (40% of all paediatric malignancies)
5. Acute Lymphoblastic leukemia pathophys?
a. ALL affects the Lymphoid cell line and comprises ~75% of leukemia cases in children.
1. Granulocytopenia?
a. A reduction in total circulating leukocytes.
6. What does AML affect?
a. Granulocytes
b. Monocytes
c. Can affect erythrocytes or megakaryocytes.
d. It comprises ~20% of childhood leukemia.
e. The clinical manifestations of AML and ALL are similar.
2. Lymphoblast?
a. A large, primitive, undifferentiated precursor cell not normally seen in the peripheral circulation.
7. Peak incidence of ALL?
a. 4 yrs old.
b. Occurs more frequently in boys.
3. Pancytopenia?
a. A reduction in circulating erythrocytes, leukocytes, and platelets.
8. S/S of ALL?
a. Nonspecific:
1. Anorexia
2. Irritability
3. Lethargy
4. Pallor
5. Bleeding
6. Petechiae
7. Leg and joint pain
8. Fever
4. Most common childhood cancer?
a. Leukemia (40% of all paediatric malignancies)
9. Physical exam for ALL?
a. Includes the child’s general appearance and energy level
b. Vital signs (note if antipyretics taken)
c. Bleeding, bruising, petechiae
d. Pallor
e. Pain upon palpating bones or joints.
f. Hepatosplenomegaly
5. Acute Lymphoblastic leukemia pathophys?
a. ALL affects the Lymphoid cell line and comprises ~75% of leukemia cases in children.
10. Differential diagnosis of presentation of ALL?
a. ITP
b. Aplastic anaemia
c. Mono
d. Juvenile RA
e. Leukemoid reaction.
6. What does AML affect?
a. Granulocytes
b. Monocytes
c. Can affect erythrocytes or megakaryocytes.
d. It comprises ~20% of childhood leukemia.
e. The clinical manifestations of AML and ALL are similar.
7. Peak incidence of ALL?
a. 4 yrs old.
b. Occurs more frequently in boys.
8. S/S of ALL?
a. Nonspecific:
1. Anorexia
2. Irritability
3. Lethargy
4. Pallor
5. Bleeding
6. Petechiae
7. Leg and joint pain
8. Fever
9. Physical exam for ALL?
a. Includes the child’s general appearance and energy level
b. Vital signs (note if antipyretics taken)
c. Bleeding, bruising, petechiae
d. Pallor
e. Pain upon palpating bones or joints.
f. Hepatosplenomegaly
10. Differential diagnosis of presentation of ALL?
a. ITP
b. Aplastic anaemia
c. Mono
d. Juvenile RA
e. Leukemoid reaction.
11. ITP vs. ALL?
a. A common cause of bruising and petechiae due to low platelet levels.
b. However, anaemia, leukocyte disturbances, and hepatosplenomegaly are absent.
12. Aplastic anaemia vs. ALL?
a. Causes pancytopenia and fever
b. Lymphadenopathy, arthralgias, bone pain, and hepatosplenomegaly are unusual findings.
13. Mono vs. ALL?
a. Both: Fever, malaise, adenopathy, splenomegaly, lymphocytosis.
b. Atypical lymphocytes resembling leukemic lymphoblasts are characteristic of mono.
14. When may Leukemoid reaction be observed?
1. Bacterial sepsis
2. Pertussis
3. Acute Haemolysis
4. Granulomatous disease
5. Vasculitis
b. The Leukemoid reaction resolves as the underlying disease is treated.
15. What may be required to differentiate ALL from other diagnoses?
a. A bone marrow examination.
16. Diagnosis of ALL?!?!
a. Almost half of the children w/newly diagnosed leukemia have total leukocyte counts LESS THAN 10,000.
b. Leukemic blasts may not be seen in the peripheral blood smear.
c. Therefore, the diagnosis of leukemia is established by examination of the bone marrow!!!
d. A minimum of 25% blasts confirms the diagnosis.
17. From where is marrow most commonly aspirated in ALL?
a. Posterior iliac crest.
18. What does a NORMAL marrow contain in terms of % blasts,?
a. < 5% blasts.
b. A minimum of 25% blasts confirms the diagnosis.
19. Genetic abnormalities in ALL?
a. ~2/3 of children have leukemic cell karyotype abnormalities, including changes in the chromosome number (ie, hypodiploidy or hyperdiploidy) or chromosome structure (translocation, deletions, inversions).
20. Prognostic markers in ALL?
a. Girls have a better prognosis.
b. Blacks and Spanish have lower remission and higher relapse rates
21. What ages of children with ALL have worse prognosis?
a. <1 or >10.
b. Higher leukocyte counts, esp if >50,000, have an unfavourable prognosis.
22. Prognosis with Mature B-cell or T-cell immunophenotypes vs. those w/B-precursor ALL?
a. Worse outcome with the mature cell types of ALL.
23. Note: The karyotypes of leukemic cells have diagnostic, prognostic, and therapeutic significance.
23. Note: The karyotypes of leukemic cells have diagnostic, prognostic, and therapeutic significance.
24. Hyperdiploidy vs. hypodiploidy and pseudodiploidy prognosis in ALL?
a. Pts w/hyperdiploidy generally have a more favourable prognosis.
25. What translocations are associated w/a poor outcome?
a. T(9;22)- Philadelphia chromosome in pts w/pre-B ALL
b. T(4;11)- seen in infants w/AML.
26. Why is a lumber puncture performed for ALL?
a. Lumbar puncture to examine the CNS for early leukemic involvement
b. A higher number of blasts in the CSF is associated w/a worse prognosis.
27. Why is a CXR performed for ALL?
a. To detect a mediastinal mass.