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102 Cards in this Set
- Front
- Back
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Common bone marrow aspirate sites:
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Adults/kids: iliac crest, sternum, vertebral spines.
Babies: tibia |
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What type of needle used for:
-Aspirate -Biopsy |
Aspirate: 16 guage
Biopsy: 8 or 11 guage, with Jamshidi-stylet, cutting edge, and tapered end. |
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How much specimen is drawn in an aspirate?
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1 ml
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How do you determine which area of aspirate smear to use for evaluating cellularity/morpholog and counting the diff?
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Near Particle; no fibrin, intact stells, good staining, not in the sinusoidal blood area.
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What steps are taken to count the diff?
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1. Estimate Megakaryocyte number
2. Look for abnormal cells 3. Count 200-1000 cells and calculate percentage of each. |
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How do you calculate the M:E ratio?
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Quantify Myeloid;
Quantify Erythroid; #grans/#erythroid:1 |
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What are Myeloid cells?
What are Erythroid cells? |
Myeloblasts/Promyelos/Myelos/Metas/Bands/PMNs/eos/basos
Pronormoblast/Basophilic/Polychromatophilic/Orthochromic |
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What are 4 reasons for doing a bone marrow exam?
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1. Investigate nonresponsive anemia or pancytopenia
2. If blasts in peripheral blood 3. Investigate abnormal lymphs 4. To evaluate leukemic therapy and how well it worked |
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What are the referance ranges for bone marrow cells?
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myeloid:erythroid Ratio = 3:1
-myeloid: mostly metas/myelos -erythr: should see rubricytes |
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Why would an M:E ratio be increased?
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Due to Myeloid hyperplasia or erythroid hypoplasia
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Why would an M:E ratio be decreased?
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Due to myeloid hypoplasia or erythroid hyperplasia.
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What is the purpose of
-Prussian Blue stain? -Silver stain? |
Prussian: to evaluate bone marrow iron stores.
Silver: to evaluate reticulin. |
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What is the definition of a stem cell?
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A stem cell has the capacity for continuous self-replication.
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What factors affect the production and differentiation of cells?
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CSFs - hematopoeitic growth factors.
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What are 2 types of CSFs?
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1. Pluripotent - affect the stem cell which is completely undifferentiated
2. Lineage-restricted - affects cells that have begun to differentiate. |
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What are the pluripotent growth factors?
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Interleukin 1,3,6
GM-CSF |
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What are the lineage-restricted growth factors?
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G-CSF
M-CSF EPO |
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What are the production sites of blood cells?
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Medullary: bone marrow.
Extramedullary: liver, spleen, only during fetal development and BM disease. |
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What does MYELODYSPLASTIC SYNDROME mean?
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A Pre-leukemia proliferation of an abnormal stem cell.
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What is characteristic feature of ALL MDS cases?
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Dyspoeisis and Progressive Cytopenia of at least one cell type.
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What are some erythroid morphologic alterations seen in MDS?
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-Megaloblastic
-Inclusions -Dimorphic population -Sideroblastic changes |
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What are some erythroid morphologic alterations seen in MDS?
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-Megaloblastoid cells
-Pelgeroid cells |
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what are some general presenting features of myelodysplastic syndrome?
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-Anemia
-Neutropenia - infection prone -Thrombocytopenia - bleeding tendencies |
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What type of progression does MDS have?
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Insidious
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Is the bone marrow infiltrated in MDS?
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not totally; it has increased cellularity though.
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How do you know MDS is not vitamin b12/folate deficiency if seeing megaloblastoid cells?
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Doesn't respond to that therapy.
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What types of inclusions are common to see in MDS?
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-Pappenheimers
-Basophilic stippling -Howell Jollies -Ringed sideroblasts *prussian* |
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What is nuclear bridging
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When daughter cells of dividing progenitors are connected by their nuclei instead of cytoplasm.
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What hemoglobin abnormalities can pop up in MDS?
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-Acquired HbH
-Acquired HbF |
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What are 4 signs of dysgranulopoeisis seen in MDS?
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1. Pelgeroid PMNs
2. Mixed eos/basos granules 3. Hypogranularity 4. Monocytosis unexplained |
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What is the name for the odd granulocytes in MDS?
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Stoddmeister - looks like a monocyte b/c it is hypogranular but it's a pmn!
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What are 4 metabolic abnormalities in grans in MDS?
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1. Decreased myeloperoxidase
2. Decreased LAP 3. Defective chemotaxis 4. Decr. bacteriocidal activity |
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What are 4 thrombocytic abnormalities in MDS?
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1. Giant platelets
2. Abnormal granulation 3. Circulating micromegakaryos 4. Hyperlobation/hypolobation |
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Because of MDS's abnormal thrombocytes, what results?
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Abnormal bleeding disorders.
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What are 4 chromosomal abnormalities associated with MDS?
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1. 5q- (50-80%)
2. 5q-, +8, 20q- (advanced stg) 3. t(5:12) (assoc. w/ CMML) 4. -7 (assoc. w/ transit to AL) |
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Based on number of blasts, what distinguishes MDS for FAB? WHO?
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FAB: Less than/equal to 30% of all nucleated cells are blasts.
WHO: less than/equal to 20% |
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What's the definition of "Myeloproliferative Disorder"?
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-A clonal neoplastic disease of pluripotent hematopoeitic stem cells.
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How does a Myeloproliferative disease differ from a reactive leukemoid rxtn?
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Myeloprolif is monoclonal;
Leukemoid is polyclonal, in response to infectn/inflamm. |
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Which myeloprolif disorder especially causes splenomegaly?
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IMF - Agnogenic myeloid metaplasia.
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Which myeloprolif disorder is associated with Chromosomal abnormality? What is it?
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CML - Philadelphia chromosome, t(9,22)
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Which myeloprolif disorders do you see megakaryocytes in?
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All of them.
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What is Polycythemia by itself?
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Increased RBCs only
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What is Polycythemia vera?
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PANmyelosis - increased RBCs, WBC, and Platelet count!!
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What is a relative polycythemia?
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A RELATIVE RBC increase due to decreased plasma volume
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What 2 things can cause relative polycythemia?
What confirms Relative polycythemia? |
1. Dehydration
2. Stress erythrocytosis. Blood volume studies. |
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What are the 2 forms of Absolute polycythemia?
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1. secondary polycythemia
2. Polycythemia vera |
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What is 2' polycythm?
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An increase in marrow erythroid precursors due to increased erythropoeitin.
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What causes the increase in EPO in 2' polycyth?
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DECREASED O2 SUPPLY
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What 2 mechanisms decrease the o2 supply to stim EPO productn?
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1. Hypoxia -> 5 causes.
2. Disease state -> 5 causes |
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What 5 things cause hypoxia?
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1. Cardiopulmonary dysfunction
2. Decreased blood volume 3. high altitude 4. Decreased Hb 5. Decreased O2 affinity |
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What 5 disease states cause hypoxia?
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1. Renal ischemia
2. Renal artery stenosis 3. Renal casts 4. Hydronephrosis 5. Tumors on kidney/liver - produce EPO active substances. |
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What are major diffncs btwn 2' and 1' Polycythemia?
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-Primary doesn't have increased EPO levels, 2' does.
-Primary has normal O2 saturatn, it is decreased in 2'. -All cells are increased in 1', only RBCs in 2'. |
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What are similarities btwn 1' and 2' polycythemia?
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-Both have increased RBC mass
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What additional findings show up in polycyth vera and not 2'?
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-Increased LAP
-Increased B12 -Splenomegaly |
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What additional lab findings show up in progressed polycythemia vera?
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PB: increases in young cells, dacrocytes, anemia, leukopenia and thrombocytopenia.
BM: increased myelofibrosis, reticulin/collagen fibers. -Develops into ANLL. |
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What 3 major findings diagnosie polycythemia vera?
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1. Splenomegaly
2. Increased cell mass 3. Normal O2 saturation |
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What 4 minor things can diagnose Polycythemia vera (if you have 2, plus 2 major)
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1. Plt count over 450,000/uL
2. WBC count over 12,000/uL 3. Increased LAP 5. Increased B12 |
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What causes the symptoms seen in polycythemia vera?
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Sluggish blood - so many platelets, increased viscosity and blood volume.
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How is polycythemia vera treated?
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phlebotomy
P32 + phlebotomy Hydroxyurea to suppress myelos. |
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What can polycythemia vera turn into?
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1. Idiopathic myelofibrosis
2. Idiopathic thrombocythemia 3. ANLL |
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How can you best differentiate between a leukemoid and a chronic myeloprolif disorder?
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1. Leukemoid has high LAP and limited young cell forms.
2. leukemia has LOW LAP, more immature forms, and unexplained baso/eosinophilia. |
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Between an acute and chronic leukemia, which has increased platelets? which has low plts?
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Chronic has normal to increased.
Acute has low platelets. |
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What cell structure do Myeloperoxidase, SBB, NCE, and NSE all stain?
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Primary granules - myeloblasts and beyond, except NSE which is monoblasts and beyond.
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If NaF is negative after a positive NSE, what does it tell you?
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It's definitely a monoblastic leukemia.
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What does TdT stain?
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the nuclei of lymphoblasts
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What does PAS stain?
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Glycogen in everything; useful in M6 b/c it stains the cytoplasms.
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What are the key morphological characteristics of ALL?
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No granules; No auer rods; Small sized cells; denser chromatin; small, fewer nucleoli.
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What symptoms can be seen in all of the acute leukemias?
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-Bleeding b/c of decr. platelets
-Anemia b/c of decr. RBCs -Increased infections b/c of decreased PMNs. |
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What symptoms are characteristic of monocytic leukemia?
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Hypertrophic gums and mucosal areas.
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What symptom is characteristic of Tcell leukemias?
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Mediastinal mass (thymic involvement)
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What cytochemical stain is positive in Megakaryocytic leukemia?
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Platelets = peroxidase positive.
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What markers identify megakaryocytic leukemia?
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CD41 and CD61
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What are the Chronic lymphoproliferative disorders?
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1. B-CLL (and prolymph transf)
2. T-CLL 3. Prolymphoctic leukemia 4. WDLL-Leukemic phase 5. Sezary 6. Hairy cell 7. Hodgkin's Disease 8. Plasma Cell Myeloma (mltpl) 9.Waldnstrom's Macrglblinemia |
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Describe the PB and BM findings for B-CLL:
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PB: monomorphic lymphocytosis with smudge cells
BM: slow infiltration of the same. |
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Describe the PB and BM findings for T-CLL
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PB:lymphocytosis with large granular lymphs
BM: rapid infiltration of the same, as well as dissemination to the skin and CNS. |
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Describe the PB and BM findings for Prolymphocytic leukemia
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PB and BM are filled with prolymphocytes.
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Describe the PB and BM findings for WDLL-Leukemic phase:
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It looks like CLL.
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Describe the PB and BM findings for Sezary syndrome:
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Convulted nuclei with pearl necklace vacuoles
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Describe the PB and BM findings for Hairy cell leukemia
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Big lymphocytes with hairy cytoplasm.
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Describe the PB and BM findings for Hodgkin's Disease
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PB = NORMAL!
BM = Reed-Sternberg cells. |
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Describe the PB and BM findings for Plasma Cell (multiple) myeloma:
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PB: rouleaux
BM: nests of plasma cells |
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Describe the PB and BM findings for Waldenstrom's macroglobulinemia:
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PB: rouleaux
BM: lymphocytosis, plasmacytoid and plasma cells. |
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What clinical symptoms and lab test results are seen in CLL-B?
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Hypogammaglobulinemia, AIHA, autoimmune thrombocytopenia, and it is a long-term disease.
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What clinical symptoms and lab test results are seen in CLL-T?
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HYPERgammaglobulinemia, it is a short term disease.
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What clinical symptoms and lab test results are seen in Prolymphocytic leukemia?
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Marked splenomegally - very rapid progression after diagnosis, short-term.
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What clinical symptoms and lab test results are seen in Sezary?
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SKIN PROBLEMS
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What clinical symptoms and lab test results are seen in Hairy cell leukemia?
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Splenomegaly, Reticulin in the Bone Marrow
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What clinical symptoms and lab test results are seen in Plasma cell myeloma?
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IgG or IgA increase - bone pain and breaks, Bence Jones proteiurea, clonal excess of kappa or lambda.
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What tests are done for Plasma cell myeloma?
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-Serum protein electrophoresis
-Immunoelectrophoresis -Quantitative Ig |
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What clinical symptoms and lab test results are seen in Waldenstrom's?
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IgM; tested in same way as plasma cell myeloma, look for clonal excess of kappa/lambda light chains.
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Which has it; Waldenstrom or MM?
-Organomegaly -Hyperviscosity -Lytic bone lesions -Renal failure -Length of survival |
Organ: Waldenstrom's
Hypervisc: Waldenstrom's Bones: MM Renal: MM Better survival: Waldenstrom's |
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What is the TRAP stain?
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Tartrate Resistant Acid Phosphatase
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How does the TRAP stainwork?
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Only hairy cells don't lose their ability to stain for acid phosphatase in presence of tartrate - they resist it!
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What is the definition of LYMPHOMA?
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Malignancy of the lymph nodes
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How do you differentiate between Hodgkin's and Non-hodgkin's lymphoma?
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Hodgkin's: lymph node involvement follows lymphatics. Abnormal cells are Reed-sternberg, can find in BM.
NHL: lymphnode involvmnt has no set pattern; abnormal lymphs can be found in BM and PB. |
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In what disorders does extramedullary hematopoeisis occur?
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Chronic myeloproliferatives.
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Which FAB AMLs are "AML not otherwise categorized"?
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M0, M1, M5, M7
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Which FAB AMLs are "AML w/ recurrent cytogenetic abnormalities?"
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M2, M3, M4eos
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Which FAB AMLs are "AML with Multilineage Dysplasia"?
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M4, M6
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Which FAB AMLs are "AML Therapy related"?
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Any secondary leukemia.
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What chromosomal abnormality is associated with:
M2? M3? M3eos? M4? |
M2: t(8;21)
M3: t(15,17) M3eos: t(16:16),inv16 M4: t(9:11) M5a: t(9:11) M5b: t(8,16) |
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What age popultation is assoc w/
-CLL? -ALL? -CML? -AML? |
CLL: some kids, more older folks
ALL: children CML: mid-aged to elderly AML: older folks |
