Intro To Leukemia And Cytochemical Stains

Front 1

1. What is the purpose of performing cytochemical stains?

Back 1

1. To differentiate types of acute leukemia from one another.
   

Front 2

1. Myeloperoxidase
2. Namethe cell stage(s) that is evaluated.
3. Statethe substance the stain identifies (ex: glycogen) and the cell stainingpatterns. (which cells are positive and which are negative)
4. Interpret the results of the stainslisted.
   

Back 2

1. myeloblasts and monoblasts
2. peroxidase in granules of cells
3. Black/blue/brown precipitate stain
4. AML positive (myeloblast or monoblast)

Front 3

1. Sudan Black B (SBB)
2. Name the cell stage(s) that is evaluated.
3. State the substance the stain identifies (ex: glycogen) and the cell staining patterns. (which cells are positive and which are negative)
4. Interpret the results of the stains listed.
   

Back 3

1. myeloblasts and monoblasts
2. Stains lipids, neutral fats, and phospholipids found in neutrophils and monocytes.
3. black staining granules
4. AML positive (myeloblasts and monoblasts)

Front 4

1. Specific esterase (Napthol AS-D Choroacetate esterase)
2. Name the cell stage(s) that is evaluated.
3. State the substance the stain identifies (ex: glycogen) and the cell staining patterns. (which cells are positive and which are negative)
4. Interpret the results of the stains listed.
   

Back 4

1. myeloblasts
2. identifies granulocyte esterase
3. bright red stain across the cell indicate positive reaction
4. positive indicates AML, myeloblasts only

Front 5

1. Nonspecific esterase (NSE) (alpha-napthyl acetate esterase)
2. Name the cell stage(s) that is evaluated.
3. State the substance the stain identifies (ex: glycogen) and the cell staining patterns. (which cells are positive and which are negative)
4. Interpret the results of the stains listed.
   

Back 5

1. monoblasts
2. Positive stain is black precipitate
3. Monoblasts stain black.
4. If NaF (sodium fluoride) is added to NSE stain the monoblasts will not stain.

Front 6

Periodic acid schiff (PAS)

1. Name the cell stage(s) that is evaluated.
2. State the substance the stain identifies (ex: glycogen) and the cell staining patterns. (which cells are positive and which are negative)
3. Interpret the results of the stains listed.
   

Back 6

1. Lymphoblast, Rubriblast, Megakeryoblast
   
2. PAS oxidizes glycogen, mucoprotein, HMW carbs to aldehydes which stain a bright pink color.
3. positive result is fine diffuse, coarse/granular pink
4. ALL (malignant lymphoblasts), malignant RBC blasts, megakaryocytes (diffuse)

Front 7

Terminal deoxynucleotidal transferase (TdT)

1. Name the cell stage(s) that is evaluated.
2. State the substance the stain identifies (ex: glycogen) and the cell staining patterns. (which cells are positive and which are negative)
3. Interpret the results of the stains listed.
   

Back 7

1. lymphoblasts
   
2. Immuno-fluorescent stain that catalyzes the polymerization of deoxynucleotides found in lymphocytic precursors only.
3. Positive cells fluoresce
4. Positive in ALL (L1 and L2).

Front 8

Leukocyte alkaline phosphatase (LAP)

1. Name the cell stage(s) that is evaluated.
2. State the substance the stain identifies (ex: glycogen) and the cell staining patterns. (which cells are positive and which are negative)
3. Interpret the results of the stains listed.
   

Back 8

1. Stain identifies secondary granules of neutrophils. LAP hydrolyzes napthol AS-BI phosphate which combines with a dye and changes color.
   
2. 100 PMNs are scored 0-4 based on amount of precipitate.
3. increased LAP activity seen in leukamoid rxn, polycythemia vera, and idiopathic myelofibrosis.
4. decreased LAP in CML, sideroblastic anemia, myeloproliferative disorder

Front 9

Acid phosphatase/tartrate resistant acid phosphatase (TRAP)

1. Name the cell stage(s) that is evaluated.
2. State the substance the stain identifies (ex: glycogen) and the cell staining patterns. (which cells are positive and which are negative)
3. Interpret the results of the stains listed.
   

Back 9

1. Hairy cell leukemia isoenzyme #5
2. Red precipitate due to acid phosphatase hydrolysis with naphthol AS-BI.
3. Hairy cells are TRAP cells because they are resistant to tartrate allowing them to hydrolyze with acid phosphatase.

Front 10

How do you determine the LAP for an appropriate cell?

Back 10

1. Scored 0 - 4+ based on the amount of precipitate in the PMN.
2. Count 100 PMN
3. Multiply score (ex: 3+) by number of cells that received that score (ex: 20).
4. Add the total score together.

Front 11

What are the conditions in which LAP scores are increased and decreased?

Back 11

1. Leukamoid reaction - 150 - 365; also CML of childhood which is Ph^22 neg, 3rd trimester pregnancy, polycythemia vera.
   
2. Normal - 15 - 70
3. CML (malignant granulocytes) - 0 - 24; also PNH, sideroblastic anemia, myeloproliferative disorders.

Front 12

1. What is leukemia?
   
2. Why does it occur?
3. What conditions does leukemia lead to?

Back 12

1. Cancer (malignancy) of blood and blood forming tissues.
2. Uncontrolled cell proliferation, or abnormal cell function
3. Immune suppression (acquired infections), imbalanced hemostasis (bleeding), decreased O2 carrying capacity (anemia, tissue death, organ failure).

Front 13

What differences occur between acute and chronic leukemia in time of onset and cell maturation?

Back 13

1. acute leukemia has a rapid, progressively worsening clinical course, and shows "arrested maturation" of cells.
2. chronic leukemia has an idolent clinical course, where "normal maturation" of cells is seen.

Front 14

What are general clinical findings in leukemia?

Back 14

1. anemia
2. thrombocytopenia - bleeding
3. neutropenia - infections
4. bone pain
5. weight loss
6. hepatosplenomegaly
7. lymphadenopathy
8. Rashes, tumors, CNS involvement

Front 15

What are acute leukemia lab findings?

Back 15

1. decreased to moderately increased WBC
2. Normal to decreased PLT with abnormal morphology
3. anemia

Front 16

What are chronic leukemia lab findings?

Back 16

1. Increased to markedly increased WBC
   
2. Normal to increased PLT
3. Anemia