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56 Cards in this Set

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Neutropenia
Increased neutrophil utilization
Differential: overwhelming bacterial/fungal infection, drugs, autoimmune, splenic sequestration
Lymphopenia DDX
Congenital immunodeficiency, HIV, steroids, chemo, autoimmune, malnutrition, acute infection
Neutrophilia
Absolute neutrophil count >8000
Toxic granulation, vacuolization, Dohle bodies
Neutrophilia DDX
Acute bacterial infection
Physiologic stress
Leukemoid Reaction
extreme neutrophilia with immature granulocyte precursors (left shift) that simulates leukemia
Leukoerythroblastosis
Immature granuloctyes and nucleated RBC precursos in peripheral blood
Leukoeryhtroblastosis DDX
Severe acute infection or bleeding
Infiltrate BM processes
Myeloproliferative syndromes (CML)
Extramedullary hematopoiesis
Lymphocytosis
Absolute lymphocyte count >4000 (8000 in kids)
Lymphocytosis DDX
Chronic inflammation
Viral infection
Lymphoid neoplasms (CLL)
Monocytosis
Absolute monocyte count >1000
Monocytosis DDX
Chronic infection/inflammation
Recovery from neutropenia
Myeloplastic/myeloproliferative overlap syndromes
Eosinophilia
Absolute eosinophil count >500
Eosinophilia DDX
Allergic disorder
Drug effects
Parasitic infection
Skin disease
Myeloproliferative syndrome
Neoplasm
Basophilia
Absolute basophil count >250
Basophilia DDX
Myeloproliferative syndrome (CML)
Reactive Changes in Leukocytes
Toxic granulation
Vacoulization
Dohle bodies
Acute bacterial ifnection
Neutrophilia
Syndromes due to morphologically abnormal WBCs
Pelger-Huet anomaly
May-Hegglin anomaly
Alder-Reily syndrome
Chediak-Higashi syndrome
Translocation in CML
Philadelphia chromsome t(9;22)
BCR/ABL gene fusion product
Abnormal enzyme in CML
Leukocyte Alkaline Phosphatase is always decreased
CML Peripheral Blood Findings
Leukoerythocytosis
Leukocytosis with basophilia, eosinophilia
Normal or increased PLT count
Anemia
Myeloid hyperplasia
Myeloblasts <10%
Thrombocytopenia, thrombocytosis
Polycytehmia Vera Findings
NO philadelphia chromsome
Increased RBC mass
Increased Hg
Thrombocytosis and/or leukocytosis
Serum erythropoietin is normal or Low
Clonal proliferation of RBCs
Polycythemic Phase
Increased RBC mass lead to thromboitc events, headaches, dizzines, splenomegaly, thrombocytosis, leukocytosis, increased Hg
Spent Phase
Reticulin fibrosis of marrow
Decreased RBC mass
Increased splenomegaly
Leukoerythroblastosis
Extramedullary hematopoiesis
Essential Thrombocythemia
Clinical Manifestations
Thrombotic Events
Paradoxical bleeding episodes
Essential Thrombocythemia
Blood Findings
Thrombocytosis
PLT > 600,000
Giant platelets
Increased WBC, no basophilia
Megakaryotic hyperplasia
Enlarged, mature megakaryocytes in clusters
Chronic Idiopathic Myelofibrosis
Pathology
Clonal proliferation of primarily granulocytic and megakaryotic elements with prominent reactive myelofibrosis and extramedullary hematopoiesis
CMF Pre Fibrotic Stage
Blood/BM Findings
Blood: anemia with teardrop cells, thrombocytosis with large atypical platelets, mild to no leukoerythoblasts
BM: hypercellular, clusters of atypical megakaryocytes, granulocytic Left shift
CMF Fibrotic Stage
Blood/BM Findings
Blood: anemia with numerous teardrop cells, leukoerythroblastosis, variable WBC and PLT
BM: hypocellular with greatly increased reticulin and collagen fibrosis, prominent megakaryotic hyperplasia, osteosclerosis (new bone formation)
CMF
Clinical Presentation
Hepatosplenomegaly due to EMH
Severe anemia
Fatigue, dyspnea, weight loss, night sweats, fever, bleeding
Chronic Myelodysplastic Syndromes
clonal stem cell diseases with ineffective hematopoiesis
-morphologically abnormal hematopoietic cells which do no migrate from well
Chronic Myelodysplastic Syndromes
Hematologic Findings
peripheral blood cytopenias
BM hypercellularity
Chronic Myelodysplastic Syndromes
Clinical Presentation
Idiopathic
Drug effects
Irradiation
Heavey metal intoxication
Viral infections
Megaloblastic anemias
Congenital dyserythropoietc anemia
Paroxysmal noctural hemoglobinuria
Dyserythropoiesis Morphology
Irregular nuclear borders
Bi or multinucleated
Megabloblastic change/dyssynchrony
Ringed sideroblasts
Vaculoziation
PAS positivity
Dysgranulopoiesis Morphology
Small cell size
Hypogranulation
Nuclear hypersegmentation
Hypolobation (pseudo Pelger-Huet cells)
Pseudo Chediak-Higashi granules
Dysmegakaryocytopoeisis Morphology
Hypolobation
Multinucleation
Hypogranular platelets
ALIP
Atypical localization of immature precursors
-clusters of myeloblasts and promyelocytes away from vascular structures
-most commonly in higher grade MDS
MDS
Low grade: refractory anemia with or without ringed sideroblasts
High grade: Refractory cytopenia with multilinage dysplasia, refractory anemia with excess blasts
Refractory Anemia
-ineffective erythropoeisis
-unresponsive to iron, B12, folate
-dysplasia limited to dyserthropoeisis
Refractory Anemia with Ringed Sideroblasts
15%+ erythroid precursors in BM are ringed sideroblasts
Dysplasia limited to dyserythropoiesis
Refractory Anemia with Excess Blasts
Dysplasia in all 3 lineages
Auer rods
Refractory Cytopenia with Multilineage Dysplasia
Bi or pancytopenia with dysplastic changes in BM celss of 2 or 3 lineages
Myelodysplastic/myeloproliferative overlap diseases
diseases with myelodysplastic features (abnormal dysplastic morphologic forms) but also myeloproliferative features (usually leukocytosis and/or splenomegaly)
No philadelphia chromosome
CMML-1 and CMML-2
Acute Myeloid Leukemia
not of lymphoid origin
granulocytic, monocytic, erythroid, megaloblastic
Causes of AML
idiopathic
MDS, chronic myeloproliferative syndromes, ionizing radiation, cytotoxic drugs, benzene, viral infection, smoking
AML Peripheral Blood Findings
20%+ BLASTS
Thrombocytopenia and/or anemia
WBC count variable, often high
AML BM Findings
20%+ Blasts
Extremely hypercellular
Monomorphic blast population
AML Clinical Presentation
Symptoms of BM failure
-easy bleeding/bruising (thrombocytopenia)
-fatigue, pallor (anemia)
-fever/infection (neutropenia)
AML Progonoses
Poor: secondary to MDS, previous chemo, advanced age, high WBC count
Favorable: cytogenetic
Myeloblasts Markers
CD13, CD33, myeloperoxidase
Lymphoblasts Markers
CD10, T and B Cell, TdT
Auer Rods
abnormal needle shaped myeloperoxidase crystals
-definitive evidence of myeloid (granulocytic) differentiation
-not present in AML
AML Subtypes with Auer Rods
M1, M2, M3
AML-M3
Acute Promyelocytic Leukemia
Many Auer rods per cell
Younger patients
DIC
t(15;17)
Favorable long term prognosis
AML-M4
Acute myelomonocytic leukemia (myelo and monoblasts)
Myeloblasts are positive for CD13 and myeloperoxidase (Auer rods)
Monoblasts are positive for CD14, CD65, non-specific esterase
inv(16)--> abnormal eosinophil precursors in BM
Favorable prognosis
AML-M6
Myeloblasts >20%
Dysplastic eryhtroid precursors
More than half of BM cells
Ring-shaped perinuclear vaculoes
Profound anemia
Erythroid precursors in peripheral blood
AML-M7
Acute megakaryocytic leukemia
CD41a
Platelet specific antibody against GP IIb/IIIa or vWF
Increased BM fibrosis
Down syndrome patients