Hema - Test 2

Front 1

Leukemia

Back 1

mutation of stem cells that causes impaired production of normal RBCs, WBCs, and or platelets

must ID as acute or chronic

spleen becomes site of extramedullary hematopoesis

categorized based on cell lineage and maturity

Front 2

Back 2

lsadkfj

Front 3

Acute Myeloid Leukemia (AML) causes

Back 3

usually by chromosomal translocation, causes inc oncogene expression or dec supressor gene expression

-may be caused by genetics or toxic (environ) exposure
-inversions, deletions, pt mutations, translocations

Front 4

AML diagnosis

Back 4

cytochemical stains
election microscopy
immunophentyping/flow
cytogenetics

Front 5

Clinical features of AML

Back 5

-cells dysfunc and may lead to : fever, infection
-anemia occurs and leads to: fatigue, weakness
-thrombocytopenia causes: easy bruising, petechiae (red spots from capillaries breaking), mucosal bleeding
-headache, blindness, joint pain, heart palpitations, gum infiltration

Front 6

Lab features of AML

Back 6

peripheral blood
-blood counts variable
-blasts are present
-auer rods: monoblast, myeloblasts, promyelocyte inclusions ==> if no auer rod, just say blast
-may see anemia and giant platelets
-nRBCs
-pseudo-hypo seg
-hyperseg of segs

Front 7

F cell

Back 7

many auer rods

Front 8

Diagnosis AML

Back 8

-200 WBC (peripheral blood) classified
-hypercellular BM
-20% or greater myeloblasts found in marrow or blood
-500 cell differential on BM smear

Front 9

myeloblasts distinguished by:

Back 9

auer rods
cytochemical stains
surface markers

Front 10

myeloblast vs lymphoblasts morph comparison

Back 10

Front 11

cytochemical stains

Back 11

-used to classify acute leukemias
-performed on BM smears
-(+) rxns occur wil be assoc w/particular lineage
-ID's lipids or enzymes w/in blast pop

Front 12

Myeloperoxidase (MPO)

Back 12

-stains prim grans that contain peroxidase
-myelo line will stain strongly pos
-(-) rxn differentiates ALL from AML

Front 13

Sudan Black B

Back 13

Stains phospholipids and other intracellular lips found in prim and sec grans of myeloid cells

neg in lymphs

differenctiates ALL from AML

sensitive for granulocyte precursors

Front 14

Specific esterase

Back 14

-prim grans of myeloid cells
-myeloblasts (strong +), segs, baso, masts
-eos, mono, lymphs ==neg
-specific for few of myeloid series

Front 15

Nonspecific esterase

Back 15

==monocytes
-monoblasts stain strong positive
-mono, histo, macro, megakary stain positive while granulocytes stain negative
-used to ID monoblasts and monocytes in Acute monoblastic and myelomonocytic leukemia

Front 16

Terminal deoxynucleotidyl transferase (TdT)

Back 16

=lymphoblasts
-intranuclear enzyme found in stem cells and immature lymphoid cells w/in BM
-90% lymphoblastic leukemias (B or T)
-5-10% myeloblastic leukemia
-30% of blast crisis phase of CML

Front 17

Acid phosphatase

Back 17

stains T lymphoblasts

Front 18

Tartrate resistant acid phosphatase (TRAP)

Back 18

stains B lymphocytes in hairy cell leukemia

Front 19

Periodic Acid Schiff (PAS)

Back 19

-stains glycoproteins and glycogen in many cell types
-ALL exhibits "Block staining" in lymphoblasts (left)
-erythroblasts in erythroleukemia usually exhibits intense granular pattern (right)

Front 20

immunophenotype

Back 20

-used instead of staining
-classify the clone of leukemic blasts using Abs agains cell surface markers
-particular nomenclature for type of leukemia based on:
morphologic info
immunophenotypic info
cytochemical info
unique presentation

Front 21

FAB classification of AML (acute myelocytic leukemia)

Back 21

M0 - acute myeloblastic leukemia minimallly differentiated
M1- acute myeloblastic leukemia w/o maturation
M2 - acute myeloblastic leukemia w/maturation
M3 - acute promyelocytic leukemia, hypergranular
M4 - acute myelomonocytic leukemia
M6 - erythroleukemia
M7 - acute megakaryoblastic leukemia

Front 22

M0

Back 22

acute myeloblastic leukemia minimally differentiated

lots of blasts
MPO and SBB neg
NO auer rods

Front 23

M1

Back 23

acute myeloblastic leukemia w/o maturation

at least 5% blasts are MPO and SBB pos
auer rods may be present

Front 24

M2

Back 24

acute myeloblastic leukemia w/ maturation

20% of nucleated BM cells are blasts
>10% of neutrophils beyond the pro stage
monocytic component is <20% of nonerthroid cells
50% of blasts are MPO and SBB pos
auer rods in blasts freq

Front 25

M3

Back 25

acute promyelocytic leukemia, hypergranular

have lots of promyelocytes == prim granules

-auer rods and F cells in blasts and pros
-progoagulant/fibrinolytic activity of granules results in DIC
-MPO strong pos
-hypergranular (prim grans) and hypogranular varients

Front 26

M4

Back 26

Acute myelomonocytic leukemia

myeloblasts and monoblasts

-mix of malignant cells w/both myelocytic and monocytic features
-large cells
-abundant basophilic cytoplasm
-azurophilic granules
-may show pseudopod cytoplasmic extensions
-lacy chromatin
-1-4 nucleoli
-NSE strong pos
-Specific esterase pos
-monoblasts are MPO or SBB neg
-promonoblasts

Front 27

M6

Back 27

erythroleukemia

red cell balst in marrow and perphiral blood

Front 28

M7

Back 28

acute megakaryoblastic leukemia

young megakaryroblast
-some small with scant basophilic cytoplasm
-some large w/abudndant cytoplasm and blebbing pseudopod formation
-megakaryoblastic fragments or micromegakaryocytes w/giant, hypogranular platelets
-cytochem stains not helpful
-diagnosis based on immunophenotype ***CD 41, 61

-symptoms: pallor, weakness, excessive bleeding, abdom masses
-rarest
-both children and adults

Front 29

AML w/myelodyplasia

Back 29

-primarily in adults
-dysplasia in at least 2 cell lines
-pseudo pelgeroid neuts, hypogran, nucleated adn multinucleated reds, megoloblastic features, ringed sideroblasts, micromagakary with 1 lobe
-can follow myelodysplastic syn

Front 30

acute basophilic leukemia

Back 30

-rare
-commonly occurs as blast transformation form CML
-predom circulating cell appears blast like w/1-3 neucleoli and prominent coarse basophilic granules
-special stains and immunophenotyping distinguish acute basophilic leukemia from acute promyelocytic leukemia
-CD 9, 13, 33, 34

Front 31

Acute myelofibrosis

Back 31

-rare
-pancytopenia
-marrow hyperplasia of erythroid, granulocytic, and megakaryocytic components combined w/fibrosis
-splenomegaly absent

Front 32

acute lymphoblastic leukemia (ALL)

Back 32

-malignant dz caused by mutation of lymphoid precursor cells
-results in :
anemia
thrombocytopenia
neutropenia
overpop of lymphoblasts in tissues (liver, spleen, meninges, gonads

-predom dz in children
-clinical features: bone/jt pain, hepatoslenomegaly, lymphadenopathy

Front 33

ALL 3 subtypes

Back 33

L1 (more likely in children)
-lymphoblasts small w/scant cytoplasm
-uniform in size
-indistinct nucleoli

L2 (more likely in adults)
-blast larger
-more pleomorphic
-prominent nucleoli
-contain abundant cytoplasm

L3 (leukemic phase of burkitt's lymphoma)
-intensely basophilic cytoplasm
-has many vacuoles
-more mature lymphoid cells are TdT negative = b cells