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MBChB V: ImagingHaematology
Session 2
MJ Coetzee
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Table of contents
• Haematological malignancies– Leukaemias
• Acute• Chronic
– Myeloma– Lymphoma
• Thrombosis & haemostasis– Thrombocytopenia– Haemophilia– DIC
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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)
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LymphoidMyeloid
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More mature cells: chronic leukaemias
More immature
cells: acute leukaemias
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Myeloproliferative diseases
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Organomegaly in a
patient with a
myeloproliferative
disease
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CMLChronic Myeloid
Leukaemia
Peripheral blood:neutrophils with left shift & eosinophils &
basophils
Increase in white cell layer in centrifuged blood:
“leukaemia”
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CML:Philadelphia chromosome t(9;22)
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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
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Polycythaemia verapolycythaemia = many cells in the
blood;vera = Latin for true (unexplained)
Patient ofSir William Osler in whom he first
described PV
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Many RBCs on a blood smear
Cellular biopsy in PV
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CT of oganomegaly
Splenomegaly
Bone marrow fibrosis
Idiopathic myelofibrosis
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Essential thrombocythaemia
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Gangrene in essential
Thrombocythaemia
(abnormal platelet clumping)
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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.
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Myeloblasts: peripheral blood
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Myeloblasts with an Auer rod
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AMLBone
marrow packed with
blasts
Myeloblasts with granules (granules
are typical of myeloid cells
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Lymphoidleukaemias
• Chronic lymphocytic leukaemia
• Acute lymphoblastic leukaemia
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CLL (chronic lymphocytic leukaemia): clinically
Cervical lymph nodes
Mediastinal lymph nodes
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CLL bone marrow: infiltrates
of mature lymphocytes
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CLL: peripheral blood with many lymphocytes
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CLL: laboratory
CLL cells express typical antigens op their membranes. These are detected by means of flow cytometry
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ALL: clinical picture
• Rapid course• Lymphadenopathy• Organomegaly• Haemorrhages• Infections
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ALL: lymphoblasts
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Burkitt's lymphoma/leukaemia blasts
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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
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Monoclonal band of abnormal Ig
Normal
Myeloma
Normal
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Myeloma
•Osteopenia
•Lytic lesions
•Pathological fractures
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Myeloma: rouleaux on peripheral blood
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Myeloma: plasma cells in bone marrow
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Congested veins resulting from paraproteins, esp. IgM
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Haemostasis
• Haemorrhagic diatheses– Hereditary haemorrhagic diatheses
• Haemophilia• Von Willebrand disease
– Acquired haemorrhagic diatheses• ITP
• Thromboses– Venous– Arterial
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Purpura(fine
peticchiae)
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Purpura (ecchymoses): larger bleeds
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Haemarthrosis in haemophilia
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Haemophilia: X-rays (ankylosis)
Knee
Elbow
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Haemophilia Family tree
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Haemophilia: repeated bleeds
Dark hypertrophic synovium; osteoartritis;osteophytes
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Dangerous bleeds
Bleed in floor of the mouth stretches downward and
obstructs the airways
Volkman contracture or compartment syndrome of fore arm (hand useless)
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ITP: bone marrow packed with megakaryocytes
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TTP: few platelets red cell fragments(always exclude HIV)
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Superficial thromboses: clinicallySkin necrosis
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DIC: clinical picture
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DIC: histological picture