1 mbchb v: imaging haematology session 2 mj coetzee
Post on 17-Jan-2016
225 Views
Preview:
TRANSCRIPT
1
MBChB V: ImagingHaematology
Session 2
MJ Coetzee
2
Table of contents
• Haematological malignancies– Leukaemias
• Acute• Chronic
– Myeloma– Lymphoma
• Thrombosis & haemostasis– Thrombocytopenia– Haemophilia– DIC
3
4
Leukaemias: rough classification
• Myeloid (granulated cells)– Chronic
(myeloproliferative conditions)
• e.g. Chronic myeloid leukaemia (CML)
– Acute myeloid leukaemias
• arise suddenly, deadly• e.g. acute
promyelocytic leukaemia
• Lymphoid (lymphocyte line)– Chronic
• e.g. Chronic lymphocytic leukaemia
• Course: years
– Acute lymphoblastic• arise suddenly, deadly• e.g. acute
lymphoblastic leukaemias (ALL)
5
LymphoidMyeloid
6
More mature cells: chronic leukaemias
More immature
cells: acute leukaemias
7
Myeloproliferative diseases
8
Organomegaly in a
patient with a
myeloproliferative
disease
9
CMLChronic Myeloid
Leukaemia
Peripheral blood:neutrophils with left shift & eosinophils &
basophils
Increase in white cell layer in centrifuged blood:
“leukaemia”
10
CML:Philadelphia chromosome t(9;22)
11
Target of Gleevec (drug against CML): works on signal transduction
• The normal tyrosine kinase transmits a signal from the surface to the nucleus in a controlled manner
• The abn. tyrosine kinase is an ONCOGENE that stimulates the nucleus to divide
Intracelllularsignaltransducers
12
Polycythaemia verapolycythaemia = many cells in the
blood;vera = Latin for true (unexplained)
Patient ofSir William Osler in whom he first
described PV
13
Many RBCs on a blood smear
Cellular biopsy in PV
14
CT of oganomegaly
Splenomegaly
Bone marrow fibrosis
Idiopathic myelofibrosis
15
Essential thrombocythaemia
16
Gangrene in essential
Thrombocythaemia
(abnormal platelet clumping)
17
Acute myeloid leukaemia Different classifications
FAB (French-American-British) WHO (world Health Organization)
Can represent different cell lines Myeloid cells of stages of maturation Promyelocytes Erythroblasts Platelets, etc.
18
Myeloblasts: peripheral blood
19
Myeloblasts with an Auer rod
20
AMLBone
marrow packed with
blasts
Myeloblasts with granules (granules
are typical of myeloid cells
21
Lymphoidleukaemias
• Chronic lymphocytic leukaemia
• Acute lymphoblastic leukaemia
22
CLL (chronic lymphocytic leukaemia): clinically
Cervical lymph nodes
Mediastinal lymph nodes
23
CLL bone marrow: infiltrates
of mature lymphocytes
24
CLL: peripheral blood with many lymphocytes
25
CLL: laboratory
CLL cells express typical antigens op their membranes. These are detected by means of flow cytometry
26
ALL: clinical picture
• Rapid course• Lymphadenopathy• Organomegaly• Haemorrhages• Infections
27
ALL: lymphoblasts
28
Burkitt's lymphoma/leukaemia blasts
29
Myeloma
• Vague complaints– Bone pain– Fractures– Infections– Malaise
• Please remember to determine paraproteinsin blood and urine
• 1% of cancers• > 10 % of
haematologic cancers in the US
• Annual incidence ± 4 per 100,000
• Increase in cases– ?enhanced availability
and use of medical facilities
30
Monoclonal band of abnormal Ig
Normal
Myeloma
Normal
31
Myeloma
•Osteopenia
•Lytic lesions
•Pathological fractures
32
Myeloma: rouleaux on peripheral blood
33
Myeloma: plasma cells in bone marrow
34
Congested veins resulting from paraproteins, esp. IgM
35
Haemostasis
• Haemorrhagic diatheses– Hereditary haemorrhagic diatheses
• Haemophilia• Von Willebrand disease
– Acquired haemorrhagic diatheses• ITP
• Thromboses– Venous– Arterial
36
Purpura(fine
peticchiae)
37
Purpura (ecchymoses): larger bleeds
38
Haemarthrosis in haemophilia
39
Haemophilia: X-rays (ankylosis)
Knee
Elbow
40
Haemophilia Family tree
41
Haemophilia: repeated bleeds
Dark hypertrophic synovium; osteoartritis;osteophytes
42
Dangerous bleeds
Bleed in floor of the mouth stretches downward and
obstructs the airways
Volkman contracture or compartment syndrome of fore arm (hand useless)
43
ITP: bone marrow packed with megakaryocytes
44
TTP: few platelets red cell fragments(always exclude HIV)
45
Superficial thromboses: clinicallySkin necrosis
46
DIC: clinical picture
47
DIC: histological picture
top related