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