1 / 51

Senior Academic Half Day: Malignant Haematology

Senior Academic Half Day: Malignant Haematology. Beth Harrison Department of Haematology University Hospitals Coventry and Warwickshire NHS Trust. Normal haematopoiesis Investigations in malignant haematology Approach to a patient with pancytopenia Diagnosis and management. Case 1.

twyla
Download Presentation

Senior Academic Half Day: Malignant Haematology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Senior Academic Half Day:Malignant Haematology Beth Harrison Department of Haematology University Hospitals Coventry and Warwickshire NHS Trust

  2. Normal haematopoiesis • Investigations in malignant haematology • Approach to a patient with pancytopenia • Diagnosis and management

  3. Case 1 • 35 year old male • 6 weeks recurrent throat infections • 2 weeks easy bruising • Hb 8.6 • WCC 1.2 • Platelets 12 Pancytopenia – he will need a bone marrow examination

  4. Bone Marrow Examination

  5. Normal Bone Marrow Aspirate

  6. Normal bone marrow trephine

  7. Case 1 • 35 year old male • 6 weeks recurrent throat infections • 2 weeks easy bruising • Hb 8.6 • WCC 1.2 • Platelets 12

  8. Hb 8.6 • WCC 1.2 + • Platelets 12 = Acute Leukaemia

  9. What is acute leukaemia? What is a “blast”?

  10. What is a stem cell?

  11. Case 1 + + Diagnosis = Acute myeloid leukaemia Bone marrow failure Blasts in bone marrow (+blood) Molecular diagnostics

  12. Case 1 • The Patient receives some chemotherapy • Presents to A&E • Pyrexial • Shivery, vomiting, diarrhoea

  13. Neutropenic Sepsis

  14. Neutropenic Sepsis • Treat as neutropenic without waiting for FBC result • Blood cultures • Broad spectrum antibiotics within 30 minutes of presentation • IV fluid resuscitation • Get help

  15. Fungal Pneumonia – Probably Aspergillus

  16. Management of acute leukaemia • Chemotherapy • BUT: • Filtered air • No plants or flowers • No unnecessary visitors • Washed food – no salad or grapes or black pepper • Antifungal prophylaxis • Mouthcare

  17. Indications for bone marrow • Diagnostic • Abnormal FBC • Investigation of paraproteinaemia • Bone lesions in pelvis accessible by this route • Pyrexia of unknown origin • ? TB in HIV+ • ? foreign travel / splenomegaly • Isolated splenomegaly with diagnosis unclear from PB • Staging • Hodgkin Lymphoma / Non Hodgkin Lymphoma • Treatment response • Leukaemia, Myeloma, Lymphoma etc

  18. Case 2 • 56 year old man • back pain, vomiting and constipation • Na 145 Calcium 3.25 K 5.7 Total protein 126 Urea 46 Albumin 34 Creat 565 • Hb 8.7

  19. Investigations: • Protein electrophoresis – of what? • Bone marrow examination – for what? • Skeletal survey – is what?

  20. Investigations: • Serum / urine electrophoresis • Bone marrow examination • Skeletal survey

  21. What is the diagnosis? • Multiple myeloma • First management issues? • Correct calcium • Give fluids

  22. Renal Failure in Myeloma • Light chain deposition in kidney • Hypercalcaemia • Hyperuricaemia • Dehydration • Non-steroidal anti-inflammatories • Plasma cell infiltration of kidney

  23. Urine free light chains: An old story Previous polyclonal antisera against light chains could not distinguish light chains bound into whole immunoglobulin molecules from free light chains

  24. Case 3 • 35 year old woman with 2 years of lethargy and intermittent LUQ pain • now complaining of dizziness Visible white cells

  25. Case 3 • On examination: • Massive splenomegaly Fundal haemorrhages • Diagnosis • Chronic myeloid leukaemia with hyperviscosity resulting from WCC • Immediate management • Get the white cell count down!!

  26. Myeloproliferative Disorders • Clonal, pre-leukaemic • Uncontrolled proliferation of one or more bone marrow lineages: • Red cells – primary polycythaemia • Platelets – essential thrombocythaemia • White cells (myeloid) – chronic myeloid leukaemia • Fibroblasts - myelofibrosis

  27. Myeloproliferative Disorders • Primary Polycythaemia and Essential Thrombocythaemia: • Increased vascular events • Treatment is aimed at reducing these Hb>19? Plts>700? Ask!

  28. Causes of hyperviscosity • Paraprotein (IgM > IgA > IgG) • High WCC (CML / AML > CLL) • High red cell mass (polycythaemia) • Raised platelet count • (>1,000, myeloproliferative rather than reactive)

  29. Causes of splenomegaly • Haematological • Chronic myeloid leukaemia, Myelofibrosis • Chronic lymphatic leukaemia • Acute lymphoblastic leukaemia • Lymphoma (various) • Infective • EBV • Chronic malaria • Visceral Leishmaniasis • Liver Other • HCV / HBV with portal hypertension • Any cause cirrhosis with portal hypertension

  30. Case 4

  31. Indications for lymph node biopsy • Generalised lymphadenopathy, FBC unhelpful. • (Also palpable cervical LN with mediastinal LN on CXR) • Isolated lymphadenopathy – no obvious pathology in the anatomical region drained • (ENT: nasendoscopy NAD, FNA unhelpful) • Regional lymphadenopathy with obvious primary pathology inaccessible to biopsy

  32. Findings on lymph node biopsy? • Reactive • Necrotic • Granulomatous – TB, Sarcoid? • HIV? • Metastatic Carcinoma • Metastatic Melanoma • Lymphoma

  33. Non-Hodgkin’s Lymphoma: T cell Hodgkin Lymphoma Non-Hodgkin’s Lymphoma: B cell

  34. Case 4 • Nodular Sclerosing Hodgkin Lymphoma

  35. Case 4 Treatment: Chemotherapy Radiotherapy • Risks of treatment: • Breast cancer • Thyroid cancer • Secondary leukaemia / myelodysplasia • Infertility • Other endocrine failure - early menopause • Bones • Cardiac damage (chemo + radiotherapy) Risks of treatment?

  36. Intraabdominal lymphoma

  37. PET-CT in staging lymphoma

  38. PET-CT in staging lymphoma

  39. Indolent Non-Hodgkin Lymphoma: localised to one site

  40. Aggressive Non-Hodgkin Lymphoma

More Related