French-American-British (Fab) Classification

Front 1

L1-L3

Back 1

- Acute Lymphoblastic leukemia
- differentiated based on cell size, prominence of nucleoli, and cytoplasm

Front 2

L1 in what group?

Back 2

children

Front 3

L2 in what group?

Back 3

older children and adults

Front 4

L3 in what group?

Back 4

patients with leukemia secondary to Burkitt's lymphoma

Front 5

L1 blasts, cytoplasm, and nucleoli

Back 5

- blasts are small
- no cytomplasm
- few nucleoli

Front 6

L2 blasts, cytoplasm, and nucleoli

Back 6

- blasts are large
- clefted cytoplasm
- indented nucleoli containing many prominent nucleoli

Front 7

L3 blasts, cytoplams, and nucleoli

Back 7

- blasts are large
- vacuolated cytoplasm
- basophilic nucleoli

Front 8

M0-M9

Back 8

- Acute Nonlymphoblastic Leukemia

Front 9

M0

Back 9

- myelogenous
- Undifferentiated blasts
- acute myelogenous leukemia (AML)

Front 10

M1-M4

Back 10

possession of granulocytic differentiation with varying degrees of maturation

Front 11

M1

Back 11

- myelogenous
- blasts and promyelocytes without maturation

Front 12

M1 epidemiology

Back 12

- in <18mo and middle-aged adults w/ median age 46 years
- median survival 3.5 months

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M1 Signs and symptoms

Back 13

- rapid or gradual onset resembling an infection
- history of fever, infections, fatigue, and bleeding episodes
- tenderness of bones, ulcerated mucous membranes, petechiae, and purpura
- chloroma: green tumor with increase myeloperoxidase

Front 14

M1 Lab Data

Back 14

- anemia and thrombocytopenia
- 1/3 leukocytosis, WBC>100x10^9/L
- myeloblasts, may have Auer rods
- cytochemical stains, Sudan Black B Myeloperoxidase

Front 15

M2

Back 15

- myelogenous beyond blasts
- with maturation beyond promyelocyte stage

Front 16

M2 epidemiology

Back 16

- occurrence at middle age and 60+
- 1.6x more in males than females
- patients survive 8.5 months

Front 17

Symptoms of M2

Back 17

bruising and bleeding epistaxis

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M2 Lab Data

Back 18

- WBC count higher than M1 up to 300x10^9/L
- blasts predominate, with Auer rods and azurophilic granules
- more mature myelogenous cells present

Front 19

M3

Back 19

- promyelocytic
- age around 38 years
- 2x in males
- survival 16 months
- symptoms of bruising, bleeding, fatigues, and DIC

Front 20

M3 Lab Data

Back 20

- WBC elevated or decreased
- anemia and thrombocytopenia common
- other immature myeloid cells present w/ Auer rods
- promyelocytes most common and granularity and nuclear shape varies

Front 21

M4

Back 21

- myelogenous and monos making up at least 20% each

Front 22

M4 epidemiology

Back 22

- older than 50, rare in young
- survival 8 months
- 1.4x more in males

Front 23

M4 Signs and symptoms

Back 23

- fatigue, fever, and bleeding
- leukemic cells may invade gums and cause gingival hyperplasia
- leukostasis: blockage of blood flow in the capillaries of the brain and/or lungs due to monoblasts
- DIC common

Front 24

M4 Lab Data

Back 24

- immature granulocytes and monocytes
- RBC and plt low
- WBC varies
- blasts have convoluted nuclei like monocytes, and may have Auer rods
- monocytes make up about 20%
- neutrophils hyposegmented, hypogranular, or agranular

Front 25

M5

Back 25

- pure monocytic
- monoblastic (M5a) or monocytic (M5b)
- M5a most common in teens and more common in women
- M5b in middle age and 2x more in men
- survival 5 to 8 months

Front 26

M5 symptoms

Back 26

- headaches and fevers
- bleeding from mucous membranes, weight loss, and fatigue
- gingival hyperplasia and skin lesions
- extramedullary masses

Front 27

M5 Lab data

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- WBC increased at 15 to 100x10^9/L
- monocytes and promonocytes make up 25-75%
- blasts may have gray-blue cytoplasm and pseudopods, like monocytes
- nucleated red blood cells

Front 28

M6

Back 28

- erythroleukemia
- DiGuglielmo syndrome
- immature RBCs with myeloblasts
- 50+ year
- survival 11 months
- 1.4x more in males
- bleeding

Front 29

M6 Lab Data

Back 29

- erythroid and myeloid blasts
- Auer rods in myeloblasts
- other maturing granulocytes

Front 30

M7

Back 30

- megakaryocytic
- megakaryoblasts
- rare
- 1/2 of blasts are megakaryoblasts
- children or adults
- organomegaly and bone lytic lesions more in children
- poor prognosis

Front 31

M7 Lab Data

Back 31

- pancytopenia and thrombocytopenia
- plt and neutrophils dysplastic (giant plts, pseudo-pelger
- megakaryoblasts express CD41 and/or CD61

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CD3

Back 32

T cells

Front 33

CD4

Back 33

Helper T cells

Front 34

CD8

Back 34

Suppressor T cells

Front 35

CD19

Back 35

B cells

Front 36

CD20

Back 36

B cells

Front 37

CD34

Back 37

stem cells

Front 38

Which of the following are typical characteristics of an acute leukemia?
A.) replacement of normal marrow elements by leukocytic blasts and bleeding episodes
B.) blasts and immature leukocyte forms in the peripheral blood and anemia
C.) leukocytosis
D.) all of the above

Back 38

D.) all of the above

Front 39

Myelogenous and monocytic

Back 39

M4

Front 40

Monocytic

Back 40

M5

Front 41

Myelogenous without maturation

Back 41

M1

Front 42

Lymphoblastic (one cell population)

Back 42

L1

Front 43

Characteristics of FAB M1 include:
A.) leukocytosis with maturation of the myelogenous cell line in the peripheral blood
B.) leukocytosis with maturation of the lymphocytic cell line in the peripheral blood
C.) leukocytosis without maturation of the myelogenous cell line in the peripheral blood
D.) leukocytosis with many mature leukocytes in the peripheral blood

Back 43

C.) leukocytosis without maturation of the myelogenous cell line in the peripheral blood

Front 44

The incidence of FAB M1 is:
A.) high in children younger than 18 months of age
B.) high in children between 1.5 and 12 years of age
C.) high in middle-aged adults
D.) both A and C

Back 44

D.) both children younger than 18 mo and middle-aged adults

Front 45

A mixture of myelogenous and monocytic blasts

Back 45

FAB M4

Front 46

Blasts of the monocytic type

Back 46

FAB M5

Front 47

Many coarsely granular promyelocytes with dumbell-shaped or bilobed nuclei

Back 47

FAB M3

Front 48

Myeloblasts, promyelocytes, and myelocytes

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FAB M2

Front 49

Immature leukocytic and erythrocytic cell types

Back 49

FAB M6

Front 50

Leukemia secondary to Burkitt's lymphoma

Back 50

FAB L3

Front 51

Childhood lymphoblastic leukemia

Back 51

FAB L1

Front 52

Older children and adults

Back 52

FAB L2

Front 53

Chloromas are associated with:
A.) FAB M1
B.) FAB M3
C.) FAB M4
D.) FAB M5

Back 53

A.) FAB M1

Front 54

A common characteristic of acute lymphoblastic leukemia is:
A.) bone and joint pain
B.) many blast cells with Auer rods
C.) leukocytopenia
D.) a leukemia of older persons

Back 54

A.) bone and joint pain

Front 55

Sudan Black B cytochemical stain

Back 55

lipids

Front 56

Myeloperoxidase

Back 56

enzymes

Front 57

PAS

Back 57

glycogen

Front 58

The Sudan black B cytochemical stain differentiates:
A.) acute myelogenous from acute lymphoblastic leukemia
B.) acute monocytic from acute myelogenous leukemia
C.) myelogenous leukemia from a leukemoid reaction
D.) acute myelogenous from acute myelomonocytic leukemia

Back 58

A.) acute myelogenous from acute lymphoblastic leukemia

Front 59

Myeloperoxidase differentiates:
A.) acute myelogenous from chronic myelocytic leukemia
B.) acute myelogenous and acute monocytic from acute lyphoblastic leukemia
C.) acute myelomonocytic from acute monocytic leukemia
D.) acute lymphoblastic from acute monocytic leukemia

Back 59

C.) acute myelomonocytic from acute monocytic leukemia

Front 60

Specific nature B-cell surface marker(s) membrane is:
A.) CD 79a
B.) CD19
C.) CD20
D.) all of the above

Back 60

D.) all of the above

Front 61

Patients with AML have a good prognosis if:
A.) <45 years of age
B.) Auer rods are present in blast cells
C.) Philadelphia chromosome
D.) all of the above

Back 61

D.) all of the above