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137 Cards in this Set
- Front
- Back
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Anisochromasia
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refers to variations in the amount of hemoglobin between the RBC
Iron deficiency anemia, agnogenic myeloid metaplasia, sideroblastic anemia (x-linked, is caused by abnormal production of ringed sideroblasts, The body has iron available but cannot incorporate it into hemoglobin) |
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Polychromasia
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some RBC demonstrate peculiar bluish or greyish color on routinely stained smears; In many situations such RBC are larger in size than surrounding cells and correspond to reticulocytes
- Normal samples from newborns - Extramedullary erythropoiesis, dyserythropoiesis (many situations) - regenerative anemias |
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Hypochromia
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RBC are pale, and distribution of hemoglobin is restricted to the periphery (leptocytes)
- Iron deficiency (anisocytosis and anisochromasia are frequent in that situation) - Other situations related to decreased haemoglobin synthesis |
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Tear-drop cells aka "pear shaped" or dacryocyte
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elongated RBC mimicking a tear-drop
- All situations associated with splenomegaly and/or myelofibrosis - Also: thalassemic syndromes, severe iron deficiency anemias |
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Dimorphic red cell population
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is related to the presence of two distinct populations (and not to anisochromasia)
- Transfusion of RBC (normal volume) in a macrocytic or microcytic (hypochromic) anemia - Microcytosis with elevated number of reticulocytes (therapy of iron deficiency anemias) - Some myelodysplastic syndromes: one RBC population is macrocytic and another one is microcytic and hypochromic |
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Target cells
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periphery and central zone of the RBC are rich in hemoglobin whereas an intermediate rim is devoid of color (looks like a target)
- Chronic liver diseases - Thalasemic syndromes & hemoglobin SC and C diseases - Splenectomized patients - At times in iron deficiency anemias |
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Macrocytes
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RBC larger than the surrounding ones
- Megaloblastic anemias: B12 or folates deficiencies, malabsorption, drug-induced NB: remember that volume of reticulocytes is larger than that of mature RBC (120 -140 fl vs 85 - 95 fl) |
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Schistocytes or erythrocyte fragments
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fragments of RBC of various shapes and sizes
- Mechanical fragmentation related to microangiopathic anemias or mechanical obstacles (cardiac valves), DIC - Dyserythropoietic anemias may show some schistocytes, namely megaloblastic anemias and many hereditary anemias - Agnogenic myeloid metaplasia - Disseminated solid tumors |
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Keratocytes
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one or two pairs of spicules are visible at the periphery of the RBC ( at times they are referred as helmet cells or bite cells)
- In most instances they are observed together with schistocytes |
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Microcytes in burns
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in severe burns some RBC demonstrate blebs or burst, due to high temperature: fragments of various sizes are observed, together with some schistocytes and microspherocytes
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Spherocytes
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correspond to RBC that look smaller than normal RBC, due to enhanced thickness and loss of central clear zone and appear as spheres (they look hyperchromic)
- Hereditary spherocytosis (moderate number that enhances after splenectomy) - Large number (up to 100%) in auto-immune haemolytic anemias - In association to schistocytes: the latter may change into spheres in the blood stream or after sampling : they correspond to microspherocytes - Increase MCHC, ABO HDN and other hemolytic processes) |
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Spherocytes
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Spherocytes together with polychromasia (polychromatophilic RBC or reticulocytes)
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Stomatocytes
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folded RBC leading to an aspect mimicking a mouth and its lips (slit-like appearance)
- liver disease - Many situations, including hemolytic anemias, either constitutive or acquired - hereditary spherocytosis (>%50) -cells are characterized by a alteration in the permeability of the cell membrane to sodium |
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Elliptocytes (ovalocytes)
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elongated RBC, "cigar shaped"
- Large number (up to 100%) is the hallmark of hereditary elliptocytosis (defect red cell membrane) - Low number (up to 5 - 10%) is observed in various situations, including iron deficiency and megaloblastic anemias - If they are very large = macro ovalocytes (see "macrocytes") |
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Sickle cells
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abnormal RBC shape is due to haemoglobin S crystals (polymerisation) within the cell- Hemoglobin S disease
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RBC aggregates
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are observed mainly in auto-immune anemias; in cold agglutin disease they are observed at room temperature and disappear after warming the sample
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Cold agglutinin disease
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aggregates disappear after the sample is warmed at 37°C
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Rouleaux formation
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RBC do not stick to each other in normal conditions because their external membrane is negatively charged; if neutralization occurs, RBC stick face to face, leading to the so-called "rouleaux formation"
- All inflammatory disorders (slide) - monoclonal gammopathies with excess of monoclonal immunoglobulin (does not occur in light chain myeloma) -multiple myeloma |
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Echinocytes or crenated or contracted cells
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up to 50 protrusions (spines or spurs) may be observed
- They correspond usually to an artifact (glass slides, old samples, saline solutions) - Excess in lipids (not diet fed samples) - Various congenital haemoglobin and enzymatic disorders - Acute renal failure - uinformed shaped --created RBC cz HYPEROSMOTIC solution, echinocyte = "urchin" - see in uremia & malnutrition |
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Acanthocytes
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- formation cz by alterative of lipid compositions & fludiity of cell membrane
-crenation is limited (3 to 12 spines or spurs) Hereditary acanthocytosis (abetalipoproteinemia) Liver diseases (cirrhosis) with dyslipidemia As a part of artefact, mixed to echinocytes |
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Howell-Jolly bodies
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they correspond to one chromosome that escaped during the mitotic process Dark, round, and usually unique within the RBC In normal patients, RBC cells that contain one HJ body are eliminated from the blood stream by the spleen within a few minutes
- In splenectomized patients such cells are long living - Dyserythropoietic states (production of HJ bodies is enhanced) - ONE dot on beneath the RBC surface - indication: distrubed erthyropoesis, hemolytic anemia, megaloblastic anemia, & post-specnectomy |
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Basophilic stippling
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numerous thin and dark granules scattered throughout the RBC, related to abnormal hemoglobin synthesis
- Thalassemic syndromes (including thalassemic trait) - Sideroblastic anemias (lead, drugs, idiopathic) - Lead posioning - Agnogenic myeloid metaplasia - Newborn (stippling is delicate) |
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Pappenheimer bodies
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small dark RBC inclusions ; usually one to three within the cell, they are located near the periphery of the cytoplasm
- All dyserythropoietic states lead to their production, and number may raise sharply (up to 100% of RBC) in splenectomized or asplenic patients - spots are IRON & are seen in sideroblastic anemia & hemoglobinpathies |
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Cabot rings
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remnants of the mitotic spindle, appearing as purple rings or loops within RBC
- All major dyserythropoietic changes -severe anemias (example: pernicious anemia) and lead poisoning - megaloblastic anemia |
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Babesia
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mimicks more or less malarial inclusions (often several within the same RBC)
- cz by B. microi, tick: Ixodes dammini (tick fever) - PA = plemorphic (vary shape & size) - can be vacuolated - doest not produce pigment |
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Artifact
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fixative not fully free of water
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what hallmark characteristics (on blood smear) would be identifiable to chronic granulomatous disease
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ineffective killing bacteria (x-linked)
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what hallmark characteristics (on blood smear) would be identifiable to Alder Reily
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large azurophillic granules (INCREASE muco-poly-sac-charides- Hunter, Hurler)
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what hallmark characteristics (on blood smear) would be identifiable to Chediak - Higashi
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large lysosome (fusion of primary granules) - albinism, increase to susceptibility to infection
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what hallmark characteristics (on blood smear) would be identifiable to May-Hegglin
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large platelets, decrease in Dohle bodies in: seg, mono, & lymphs (does not affect leukocyte function)
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what hallmark characteristics (on blood smear) would be identifiable to Pelger-Huet
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hyposegmented polys (normal function)
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what do the following, based on classification of anemia - do they have in common iron defcny, siderblastoic, chronic disease/inflammation
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problem with heme
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what do the following, based on classification of anemia - do they have in common thalassemia & HGB E
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problem with the globin
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what do the following, based on classification of anemia - do they have in common HGN, transfusion reactions, autoimmune hemolytic anemia
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antibody destruction
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what do the following, based on classification of anemia - do they have in common hereditary sperocytosis, hereditary elliptocytosis, paroxysmal noctural hemoglobinuria
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rbc membrane defect
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what do the following, based on classification of anemia - do they have in common g6pd, pyruvate kinase
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emz deficiency
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what do the following, based on classification of anemia - do they have in common aplastic anemia, acute blood loss
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decrease in production, loss
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what do the following, based on classification of anemia - do they have in common HGB S, HGB C, other variants
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hemoglobinopathies
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what do the following, based on classification of anemia - do they have in common B12 deficiency, folate deficiency
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megaloblastic maturation
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what do the following, based on classification of anemia - which one does liver disease fall under
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non-megaloblatic maturation
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when an rbc containing IRON GRANULES is stained with PRUSSIAN BLUE, the cell is called
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sidero-cyte (Fe + blue = sidero-cyte)
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neutrophils are highly phagocytic - name the three protein that it releases
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lysozymes, peroxidase, & pyrogenic protein (LLP)
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autoimmune disease best characterized by these four things
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1. decrease in plasma C3
2. spherocytic red cells 3. increase osmotic fragility 4. increase in unconjugated bili |
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defined aplastic anemia
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when BM can not produce sufficient new cells to replenish rbcs - which leads to peripheral blood panccytopenia (reduction of rbc/wbc/platelets)
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define micro-angio-pathic hemolytic anemia
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is a condition resulting from shear stress to the rbcs - fibrin strangs are laid down within the micro-cirucilation & red cells become fragmented as they contact fibrin through the circulation process (will mainly see SCHISTOCYTES & NUCLEATED RBCS on smear)
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what can be seen on the blood smear of autoimmune hemolytic anemia
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SPHEROCYTES
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what name 4 characteristics of hereditary pry-ro-poikil-ocytosis (a red cell membrane defect)
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1.spectrin abnormality (rbc membrane protein)
2. thermal instability 3. decrease MCV 4. budding & fragmented rbcs |
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what kind of cells will be seen in patient with thalassemia major
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target cells
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what are some (4) different characteristics of iron defncy anemia
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1. micro/hypochromic
2. elevated platelet count along with small platelets 3. increase in TIBC 4. increase in RBC pro-to-porphyrin |
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based on defectiveness, what is the difference between iron defncy anemia to thalassemia
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1. IDA is caused by a defect heme sythz
2. thalassemia is a defect in a decrease globin chain *though both are characterized as microcytic/hypochromic anemia |
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define what sideroblastic anemia is & how it is involved in ineffective erythropoiesis
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sideroblastic anemia has a decreased red cell pro-to-por-phyrin, the defect in SA involves ineffective erthyropoiesis. the failure to produce rbcs protoporphrin occurs because NONHEME iron is TRAPPED in the MITOCHONDRIA and is unavailable to be RECYCLED
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what is the basic hemo defect in patients with thalassemia major
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there is little or no production of the B-CHAIN, resulting in severly depressed or NO SYTHZ of Hgb A (which would incl, anemia, abn skeletal & enlarged spleen)
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in which of the following conditions is HGB A2 elevated
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b-thalassemia minor (recap: HGB A = thalassemia MAJOR, HGB A2 = thalassemia MINOR)
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name (4) characteristics of megagloblastic anemia
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1. pancytopenia
2. decrease retic count - MA are associated with an ineffective erythropoiesis & therefore a decrease in the retic count 3. hypersegmnt netur 4. macrocytic rbc indices |
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this disorder causes an ineffective erythropoiesis
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pernicious anemia (defective DNA sythz)
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define intrinsic factor
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a glycoprotein produced by pariental cells of the stomach, neccessary for absorption of vit B12
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if a patient was suffering from pernicious anemia, what kind of labs would you anticipate
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a LOW count of RBC, WBC & PLATELET due to pancytopenia - because this is a megaloblastic process & DNA maturation defect, ALL cells lines are AFFECTED
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patient with obstructive liver disease would anticipate what kind of blood smear
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macrocytes - because they have an increase tendency toward the deposition of LIPID on the surface of the red cells, consequently, the red cells are LARGER or more MACROCYTIC
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differentiate between which macrocytes for 1. megaloblastic and 2. alcoholism & obstructive liver disease
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megaloblastic - ovalocyte macrocytes versus
obstructive liver disease & alcoholism is ROUND macrocytes |
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name the 3 emz that are in primary granules of the neutrophils
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1. myeloperxidase
2. lysosome 3. acid phosphate (my & ly likes to eat acid phosphate) secondary/tertiary granules 1. lactoferrin 2. collagenease 3. NADPH oxidase 4. alkaline phosphatase (laco the sheep says naaaaall) |
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what is the typical relative lymphocyte % of an adult vs child
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adult = 35 - 58%
child = 50 - 70% |
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define hemolytic anemia
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disorder in which rbc are destroyed prematurely
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which hemo globin group does this belong to: 2α + 2β =
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Hgb A, (α2 β2A) 96% in normal adults
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which hemo globin group does this belong to: 2α + 2 δ =
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Hgb A2, (α2 δ2) 3% in normal adults
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which hemo globin group does this belong to: 2α + 2 γ =
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Hgb F, (α2 γ2) 1% in normal adults, (Hgb F is the main hemoglobin in the fetus, and remains abundant until the child is two years old.)
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which hemo globin group does this belong to: 4β =
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Hgb H (β4)
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which hemo globin group does this belong to: 4 γ
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Hgb Bart's (γ4)
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which hemo globin group does this belong to: 2α + 2βS =
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Hgb S (α2βS2)
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which hemo globin group does this belong to: 2α + 2βC =
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Hgb C (α2βC2)
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which hemo globin group does this belong to: 2α + 2 β-δ Lepore =
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Hgb Lepore(α2 β-δ2, which is not made in sufficient quantities)
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if both the heterophile antibody test are negative in a patient with reactive lymphocytosis & suspect viral infection, what serum testing should be done
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CMV (IgM: positive) this belongs to the herpes virus family & is endemic worldwide. CMV is the most common cause of HETEROPHILE-NEGATIVE infectious mononucleosis
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neutrophils phagocytosis & particle ingestion are associated with an increase in O2 utilization referred to a respiratory burst, what are the 2 most important products of this biochemical reaction
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hydrogen peroxide & superoxide anion (the bichem products of the respiratory burst that are involved with neutrophils particle ingesting during phagocytosis are HP & SA. the activated neutrophil discharges the emz NADPH oxidase into the PHAGOLYSOSOME where it converts O2 to superoxide anion (O2 - ) which is then reduced to hydrogen peroxide (H2O2)
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define shift to the left
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indicates the increase presence of these less mature form relative to their mature ones
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name 3 morph characteristics of reactive lymphocytes
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high nuclear: cytopasmic ration
promient nucleoli basophillic cytoplasm *note: blast & RL both have basophillic cytoplasm, high N:C ration & presence of prominent nucleoli --blast however, have an extremely fine nuclear chromatic staining patterned viewed on wright giemsa stain |
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define leukemia
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is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes)
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if auer rods are not seen in lymphoblasts, name the three cells that they are seen in
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myeloblastsm, promyelocytes & monoblasts
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which type of anemia is usually present in a patient with acute leukemia
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normocytic & normochromic
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in leukemia, which term describes a blood smear finding of leukocytosis with a shift to the left, accompannied by occasional nucleated red cells
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leuko-erythro-blastosis (myelophthsis refers to replacement of BM by a disease process such as neoplasm (aka tumor, new growth of tissue serving no physiological ftx - the development of abn tissue is called dysplasia)
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define leu·ko·e·ryth·ro·blas·to·sis
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anemic condition resulting from space-occupying lesions in the bone marrow and characterized by the presence of immature granular leukocytes and nucleated erythrocytes in the circulating blood. Also called myelophthisic anemia.
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name about 6 different things that can happen when the basic pathophysiological mech responsible for producing signs & symptoms in leukemia
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a normal physiology response to anemia would be an INCREASE in kidney's production of erythropoietin, the accumultx of leukemic cells in the BM lead to marrow failure, which is manifested by anemia, thrombocytopenia & granulocytopenia
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which type of acute myeloid leukemia is called "true" monocytic leuk & follows an acute or subacute course characterized by monoblasts, promonocytes & monocytes
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acute monocytic leukemia
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name some of the characteristics of acute monocyte leukemia
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AML has an incidence of 1 - 9% of all leuk, it has distinctive clinical manifestation of monocytic inv resulting in skin & gum hyperplasia (constant cell dividing), the wbc count is markedly elevated & prognosis is poor
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in which age group does acute lymphoblastic leuk occur w/ the highest frequency
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1-15 years (acute lymphoblastic leukemia)
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which leukemia is the single most prevalent malignancy in pediatric patient
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acute lymphoblastic leukemia
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dic is most often associated with which of the following acute leukemia
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acute promyelocytic leuk
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why does acute promyelocytic leuk cause dic
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the azurophillic granules in the leukemic promyelocyte in patients w/ APL contains thromboplastic substances, these activate soluble coag fxt which when released into the blood cause dic
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an M:E ratio of 10:1 is most often seen in
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thalassemia (normal 1.5 - 3.0)
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name a characteristic of an auer rod
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they are composed of azurophilic granules - AR are linear projection of primary, azurophilic granules & are present in the cytoplasm of myeloblasts & monoblast in patient with acute leuk
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phospholipids, neutral fats, & sterols are stained by
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sudan black B
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PAS reaction stains
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intracellular glycogen
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myeloperoxidase is
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an emz present in the primarily granules of myeloid cells & to a lesser degree in monocytic cells
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terminal deoxynucleotidyl transferase (TdT) is
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DNA polymerase found in thymus derived & some BM derived lymphocytes
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sodium fluoride may be added to naphthyl ASD acetate (NASDA) esterase reaction - the fluoride is added to inhibit a positive reaction with
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monocytes (NASDA stains monocytes (& monoblasts) and granulocytes (& myeloblasts). the addition of fluoride renders the monocytic cells (& blasts) negative, thus allowing for diff from the granulocytics cells, which remains positive
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leukemia lymphoblasts reacting with anti-CALLA (common acute lymphoblastic leuk antigens) are characteristically seen in
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common ALL (
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which of the following reactions are positive in ALL but are negative in AML
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terminal deoxynucleotidyl transferase & PAS
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how does the World Health ORgtzn classification of myeloproliferative disorder diff from the French American British classification scheme for acute leukemia
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it encompasses all the myeloproliferative disease including CML
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in addition to morph, cytochemistry & immunophenotyping, the WHO classification of myelo and lympholiferative disorders is based upon which characteristics
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cytogenic abn (the WHO classification relies heavily on chromosomal & molecular abnormalities)
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the WHO classification of AML is best characterized by
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four subtypes with commonly occurring translocation emphases most cases in AML
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repeated phlebotomy is patients with polycythemia vera may lead to the development of
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iron defncy anemia - is a predictable complication of therapeutic phlebotomy because approx 250 mg of iron is removed with each unit of blood
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in essential, thrombo-cythemia - the platelets are
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increased in numbers & functionally abnormally (ET - the platelet count is extremely elevated, these platelets are abn in ftx, leading to both bleeding & thrombotic diathesis
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which of the following cells are considered "pathognomoic" for hodgkin's disease
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reed sternberg cells ("owls eyes appearance)
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what disorder can niemann pick cells be seen
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aka foam cells, are histiocytes containing phagocytized spingolipids that stain pale blue & impart a foam like texture to the cytoplasm
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what disorder can flame cells be seen
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are plasma cells with distinctive red cytoplasm - they are sometimes seen in the BM of patient with mx myeloma
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PV is characterized by
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absolute increase in total red cell mass
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name 3 features of secondary polycythemia
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1. red cell mass is increased (both in primary PV too)
2. erythropoietin is increased & O2 saturation is decreased in secondary polycythemia |
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what feature is seen in primary polycythemia and not in secondary polycythemia
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splenmegaly
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what feature would BOTH primary and secondary polycythemia have in common
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their red cell mass would be increased
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the erythrocytosis seen in relative polycythemia occurs because
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decrease in plasma volume of circulating blood
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relative polycythemia is caused by
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reduction of plasma rather than an increase in red blood cell volume or mass - red cell mass is increased in both PV & secondary polycythemia - but erythropoietin levels are high ONLY in SECONDARY polycythemia
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in PV what is characteristically seen in the smear
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pancytosis (PV is a myeloproliferative disorder characterized by uncontrolled proliferation of erythroid precusors. however, production of all cell lines is usually increased
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pan-hyper-plasia is a term used
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to describe the cellularity of the BM in PV
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CML is distinguished from leukomoid reaction by
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CML - LOW lap
Leukomoid - HIGH LAP!!! |
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what is the common characteristics of CML & leukomoid
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both have a high WBC count
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name 5 disorders that can occur with idiopathic myelofibrosis
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anemia, fibrosis, myeloid metaplasia, thrmocytosis, & leukoerythroblastosis
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what influence does the Philadelphia (Ph1) chrom have on the prognosis of patient with chronic myelocytic leukemia
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the prognosis is better if the Ph1 is present
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since 90% of patient with CML have the Philly chrom, what has happened to the chrom that caused this
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this appears as a long arm deletion of th chrom 22, but is actually a translocation betwee the long arms of chrom 22 and 9. often, a second chrom abnormality occurs in CML before blast crisis
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define heme
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an iron compound of protoporphyrin which constitutes the pigment portion or protein-free part of the hemoglobin molecule and is responsible for its oxygen-carrying properties.
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define protoporphyrin
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any of several porphyrin isomers, one of which is an intermediate in heme biosynthesis; it is accumulated and excreted excessively in feces in erythropoietic protoporphyria and variegate porphyria
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define porphyrin
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A type of pigment found in living things, such as chlorophyll, that makes plants green and hemoglobin which makes blood red.
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what are commonly found (blood smear) in CML (8 characteristics)
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CML is marked with elevated WBC count demo various stages of maturation, hypermetabolism, & minimal LAP staining. an increase basophils & eosin is common with pseudo-pelger huet cells & thrombocytosis may be present, the marrow is hypercellular with high M:E ratio (10:1)
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name 3 things that mx myeloma & waldenstroms macroglobulinemia have in common
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monoclonal gammopathy, hyperviscosity of the blood & bence-jones protein in the urine
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name 1 thing that sets mx myeloma & waldenstroms macroglobulinemia apart from one another
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MM: osteolytic lesions are only seen because this indicating destruction of the bone as evidence by radiography
WM: gives rise to lymphocytosis & differs in morphology of the malignant cell |
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define Waldenström's macroglobulinemia
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(aka lymphoplasmacytic lymphoma) is cancer involving a subtype of white blood cells called lymphocytes. The main attributing antibody is IgM. It is a type of lymphoproliferative disease, and shares clinical characteristics with the indolent non-Hodgkin lymphomas
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what characteristics finding seen in the blood smear of a patient with mx myeloma
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rouleaux - which result of increased viscosity & decrease in albumin/globulin ratio
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which of the following conditions does LAP show the least activity
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CML
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a striking feature of the peripheral blood of a patient with CML is
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presence of granulocytes @ different stages of development (from myeloblast to seg neut) - the WBC count is often higher than 100 x 10 9/L
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what does CML & AML have in common (name 3)
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infections, wbcs greater than 20.0 x 10 9/L, hemorrhage
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name one thing that sets CML and AML apart
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splenomegaly (enlargement of the spleen) is seen in more than 90% in CML
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what does the spleen do
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function in the destruction of excess RBCs & holds a reservoir of blood (works with immune system)
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name 3 things associated with diagnosis of mx myeloma
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marrow plasmacytosis, lytic bone lesion, serum and or urine M component (monoclonal protein)
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mx myeloma is most difficult to distinguish from
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benign monoclonal gammopathy
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what are some characteristics of Monoclonal gammopathy of undetermined significance (MGUS, formerly benign monoclonal gammopathy
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is a condition in which monoclonal antibody is found in the blood during standard laboratory tests. It resembles multiple myeloma and similar diseases, but the levels of antibody are lower, the number of plasma cells (white blood cells that secrete antibodies) in the bone marrow is lower, it has no symptoms or problems, and no treatment is indicated
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the pathology of mx myeloma includes what (3 of these)
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expanding plasma cell mass, overproduction of monoclonal immunoglobulins & production of osteoclasts activating facter (OAF) and other cytokines
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waldenstrom macroglobulinemia is a malignancy of the
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lympho-plasmacytoid cells (ca abn IGM), although the cells secrete immglbn, they are not fully differentiated into plasma cells & lack the chracteristics perinuclear halo, deep basophilia & eccentric nuc
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cell that exhibit positive stan w/ acid phosphatase are not inhibited with tartaric acid are characteristically seen in
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HCL (hairy cell leuk)
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what does HCL (hairy cell leuk) have in common with TRAP
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a variable number of maligant cells in HCL will stain positive with tartrate resistant acid phosphatase (TRAP +), although this cytochem rxt is fairly specific for HCL, TRAP activity have occasionally been reported in B-cell & rarely T-cell leuk
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define HCL
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disease in which lymphocyte present in the MM & blood become malignant & proliferates
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