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43 Cards in this Set

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AML peripheral smear - The 3 blasts have a high N:C ratio and prominent nucleoli (pale area in nucleus)
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AML - blast cell w/ auer rod
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normal bone marrow - Heterogeneous mixture of myeloid and erythroid cells
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AML bone marrow - increased numbers of blasts (note prominent Golgi area in cytoplasm of blasts)
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AML - MPO stain - MPO is present in immature and mature granulocytes and stains black
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AML Esterase Stain - CAE & ANAE - granulocytes and monocytes - will stain mature and immature granulocytes blue
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ANAE - Monoblasts/Monocytes - will stain mature and immature monocytes brown
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AML – note the absence of normal hematopoietic cells
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AML – some of the nuclei are folded - Consistent with monocytic differentiation
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AML - Blast with folded nucleus
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Blast with Auer rods
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AML
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AML - Bone marrow clot section - not a lot of megas, not a lot of diff – very bad
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bone marrow in Lekukmia – sheets of blasts, maked reduction in normal hemapoitic cells
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L1 - high N/C ratio
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L2 – looks like myelobasts
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L3
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ALL smear
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ALL - bone marrow aspirate
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ALL Bone marrow clot section - too monotonous - Note the absence of normal hematopoietic precursors
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ALL - Lymphoblast in CSF
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Leukemia - def
- cancer of BM progenitor cells
- malignant, monoclonal prolif of hematopoietic cells from the BM
- abnormalities of cell prolif, diff, and termination
Decreased apoptosis in leukemia
- common in lymphoid
- BCL2 overexpression in some NHL
Blocked differentiation in leukemia
- common in myeloid
- t(15;17) is classic example
Pancytopenia - definition and causes
- decreased production of BM cells
- if BM infiltrated, its probably leukemias, mets solid tumors, MF
- If BM hypoplastic (decdevelopment), its prob aplastic anemias, infection, or metabolics
AML - Histologic subtypes
M1 - M7 - just know that M3 is common and associated w/ DIC
AML - diagnosing BM failure
- Neutropenia
- Anemia
- Thrombocytopenia
AML - diagnosing
- Peripheral blood and BM - increased blasts (>20%) and auer rods
- Cytochemistry - MPO, SBB, or esterase stains
AML - genetics
- t(15;17) - APL - good prog
- t(8;21), t(16;16) and inversion 16 - good prog
- -7, -5 have poor prog
AML - WHO classification
1) AML with recurrent genetic abnormalities
2) AML with multilineage dysplasia
3) AML therapy related
4) AML no otherwise specified (M0-M7)
AML - treatment
- Allogenic transplantation > autologous trans > intensive chemo
- Drugs include all-trans-retinol, all-trans-retinoic acid, and #s w/ retinoic acid
- 6 months in patient
ALL - classifications
- L1 - Small cells, no granules TdT+ - most common
- L2 - larger cells w/ big nucleoli – common in adults
- L3 (ass w/ EBV) - vacuolated cells – poor prognosis – t(8;14), t(8;22), t(2;8)
ALL - diagnosing
- Flow cytometry!! - most kids have CD10 mophology – precursor B cell
- look for ITP, aplastic anemia, Reactive Lymphocytosis
- In BM - inc blasts, (>30%) - decreased hematopoiesis
ALL - causes
- almost always an unusual reaction to a common viral infection
- disease of childhood
ALL - Immunophenotyping
- Low numbers - T-cell phenotype (CD 1-8)
- Midteens - Myelomonocytic 13 and 15 - Granulocyte, 14 - Monocytic
- 19-23 - B-cell phenotype
- 38 - B-cells/plasma cells
- 34 - stem cell
- 33 - myeloid
ALL - Precursor B-cell flow cytometry
- + for CD10, CD19, CD34
- usually neg for k & l and B cell markers in mature B-cells (CD20, CD22)
ALL - Mature B-cell flow cytometry
- + for CD10, 19, 20, 22
- + for either the k or l light chain
- Negative for CD34
ALL - Precursor T-cell flow cytometry
- + for CD3, CD4 and CD8
ALL cytogenetics
- good prognosis - hyperdiploidy (50 or greater chromosomes)
- bad - Philadelphia chromosome (t(9;22)), t(4;11), t(8;14), hypodiploidy
ALL - Treatment
- 2-3 years outpatient
– augmented therapy does better than standard therapy
- do best if 2-10 – want WBC to be low
ALL - 9-22 translocation
- mainly in adults – looks like CML – 3-5% - do horribly
ALL - 4-11 translocation
– babies and high WBC – do very bad
ALL - 8-14 translocation
- in c-myc
- burkitts lymphoma