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73 Cards in this Set

  • Front
  • Back
Leukemoid rxn
Benign, Elevated leukocytes count response to infection

Perforating appendix (PMNs)
Whooping cough (lymphocyte)
Cutaneous larva migrans (eosin)
In what pts to you find a leukoerythroblastic rxn

Blood findings
Women > 50 associated with metastatic breast CA

Peripheral blood:
Nuleated RBCs and tear drop RBCs
Causes of Neutrophilia

Suggestive findings
1. Pyogenic bacteria infection
2. CS, stress - decr neutrophil adhesion molecules on endothelial cells

1. Incr bands (Left shift) in peripheral blood
2. Increased Leukocytes Alkaline Phosphatase indicates benign rxn VS. CML in which LAP in elevated
Causes of neutropenia
1. Aplastic anemia
2. Septic shock
3. SLE - immune destruction
Job's syndrome
Disorder of neutrophils, charcaterized by abn chemotaxis leading to COLD soft tissue abscess due to Staph aureus.
Red hair, leonine face, eczema, incr IgE
Causes of eosinophilia
1. Type I - Allergy and Asthma
2. INVASIVE Helminth (NOT enterobius and ascariasis)
3. Hypocortisolism (Addison's) - NO sequestration of eosin in lymph
4. Adenocarcinomas
Causes of esosinopenia
1. Hypercortisolism - Cushing's
2. CS - Sequester eosin in lymph nodes
Causes of monocytosis
1. Chronic Infection - TB
2. AI - SLE, IBD
3. malignancy
Causes (4) of lymphocytosis
1. Viral infection
2. Bacterial - B. pertussis ( produces lymphocyte-promoting factor
3. Drugs - phenytoin
4. Graves Dz
Causes of atypical lymphocytosis
1. Infection - Mono, hepatitis, CMV, toxo
2. Drugs - Phenytoin
Pathogenesis of IM
EBV initially replicates in salivary glands - disseminates and invades B cells via CD21 receptor - CD8 T cells respond against invaded B cells and form atypical lymphocytes (DOWNEY CELLS) = enlarged lymphocytes with abundant cytoplasm
DF of atypical lymphocyte
Antigenically stimulated CD8 T cells
Lab and clinical findings suggestive of IM
Lab: Postive heterophil Ab test - IgM Ab directed against horse, sheep, and bovine RBCs

1. Fever
2. Sore throat
3. Posterior auricular lymphadenitis
4. Hepatosplenomegaly
Causes of lymphopenia
1. HIV
2. DiGeorge, SCID
3. SLE - immune destruction
4. CS
5. Radiation - lymphocytes are most sensitive to destruction by radiation
What type of hematologic findings are associated with CS use
Neutrophilic leukocytosis (neutrophilia)
Eosinopenia and lymphopenia
Pt presenting with Fever, sore throat, post. auricular lympaditis is Tx with an abx and develops a rash
T cell area of the lymph node?

B cell rich region of the lymph node?
Paracortex (T cell rich)

Primay follicle (B cell rich)
Leukemias by age grp and cell type of each
Acute Leukemia:
ALL: Newborn - 14; lymphoblast (pre-B or Pre-T)
AML: 15-60; myeloblast

Chronic Leukemia:
CML: 40-60; myeloid stem cell, blast crisis
CLL: > 60;; Lymphocyte, Non-Ab producing B cells
General findings in Leukemias
1. Incr # of circulating leukocytes in the blood
2. Monoclonal proliferation of neoplastic leukocytes behind the block in stem cell differentiation
3. Leukemic cells infiltrate bone marrow - replace nml hematopoetic cells - cause marrow failure: Decr RBCs (anemia), Decr WBCs (infection), Decr Platelets (bleeding)
Presentation of Acute VS. Chronic Leukemia
1. Abrupt onset of fever, fatigue, bleeding
2. Bone pain and tenderness - expansion by leukemic cells
3. Hypercellular bone marrow Blasts > 20%

1. Insidious onset
2. Hypercellular bone marrow, <10% blasts

1. Hepatosplenomegaly
2. General lymphadenopathy
What are the 3 categories (subcategories) of myeloproliferative disorders
1. Myelodysplastic syndrome
2. AML
3. Chronic myeloproliferative Disorders
a. PCV
b. CML
c. Myeloid metaplasia w/myelofibrosis
d. ET
Myelodysplastic syndrome
1. Men 50-80
2. Pre-AML (Therefore, blast must be less than 20%)
3. Ringes sideroblasts (nucleated RBCs with excess iron)
4. Pancytopenia - normocytic to macrocytic anemia
15-60 yo
M0 - M7
Myeloblastic leukemia w/o differentiation
Myeloblastic leukemia w/maturation (some promyelocytes)
Auer rods
MC type (30-40%) of cases
Acute promyelocytic
DIC present (Tx can release auer rods - DIC)
t(15;17) translocation
Tx contains trans-retinoic scid
Auer rods
Seen in M2 M3 (MC)
Peroxidase-positive (MPO) cytoplasmic inclusion in myeloblasts
Acute myelomonocytic (has both myeloblasts and monoblasts)
Acute Monocytic leukemia
Infiltrates gums
Acute erythroleukemia
Multinucleated erythroblasts
Acute megakaryocytic
Myelofibrosis in bone marrow
Down syndrome children <3
1. 40-60 y.o
2. Leukocytosis with cells in different stages of development in peripheral blood
3. Slow progression, then blast crisis ~5 yrs (bad prognosis, 2/3 myeloblasts, 1/3 lymphoblasts)
4. Philadelphia chromosome t(9;22) translocation of the ABL proto-oncogene on 9 to form BCR-ABL fusion, which has tyrosine kinase activity
5. BCR-ABL fusion gene is most sensitive and specific test for CML
6. Decr Leukocyte Alakaline Phosphatase
Hydroxyurea to control

Bone marrow transplant
Lab findings in PCV
1. Findings:
RBC Mass Incr
Plasma Volume Incr
Sao2 Nml
EPO Decr
Hb, Hct, RBC count Incr (as with all polycythemias)
2. Increased basophils and eosin (as with all oth MPS)
Clinical finding and sequalae of PCV
Signs of increased histamine - Red face, pruritis after bathing, PUD

DVT, hyperuricemia / gout
Increased risk for acute leukemia
Lab findings and Ex of relative Polycythemia
Hb, Hct, RBC count Incr
RBC Mass: Nml
Plasma volume: Decr
Sao2: Nml
EPO: Nml

EX: Volume depletion
Lab findings and Ex of Appropriate Polycythemia
Hb, Hct, RBC count Incr
RBC Mass: Incr
Plasma volume: Nml
Sao2: Decr

EX: COPD, cyanotic congenital heart Dz
Lab findings and Ex of inappropriate Polycythemia
Hb, Hct, RBC count Incr
RBC Mass:Incr
Plasma volume: Nml
Sao2: Nml
EPO: Incr

EX: Ectopic Epo - Renal Dz
Incr platelets, but are nonfunctional
Present with bleeding,
mild neutrophilic leukocytosis, splenomegaly
Myelofibrosis and myeloid metaplasia
1.Massive splenomegaly with portal hypertension
2. Bone marrow fibrosis due to stimulation of fibroblasts
3. Normocytic anemia with tear drop cells (damaged RBCs) and leukoerythroid reaction
What are the 4 types of lymphoid leukemia
1. ALL (Pre-B or Pre-T cell)
2. Adult T cell leukemia (HTLV-1)
3. CLL (B cell)
4. Hairy cell leukemia (B cell)
ALL Pre-B type
Newborn - 14 y.o
CD10 +, TdT (deoxynucleotidyl transferase) +

>20% lymphoblasts in peripheral blood
Bone marrow replaced by lymphoblasts
Normocytic anemia

Commonly mets to CNS and testes (sanctuary sites)
ALL T-cell
Newborn - 14 y.o
CD10 -
TdT +
Mediastinal mass in young adolescents

>20% lymphoblasts in peripheral blood
Bone marrow replaced by lymphoblasts
Normocytic anemia
> 60 y.o
Virgin B cell leukemia
MCC of general lymphadema in >60

CD19, CD20
CD23 +, CD 10-

Associated with warm AIHA (IgG), which will see spherocytes in the blood

Lymphoblasts <10% of peripheral blood
SMUDGE cells present (fragile neoplastic lymphocytes)
Adult T cell
HTLV-1 association
CD4 +
TdT -
Skin infiltration
Lytic bone lesions with hypercalcemia
Hyperlobulated 4-leaf clover lymphocytes in peripheral blood
>20% lymphoblasts
Normocytoc anemia
Hairy cell
B cell leukemia
Cytoplasmic projections
Dx: TRAP stain +
ONLY leukemia W/O lymphadenopathy
Marked Splenomegaly

Tx: 2-chlorodeoxyadenosine - inhibits ADA; often associated with marked improvement
Clinical presentation differentiating Benign from Malignant lymphadenopathy
Inflammation (Benign): Painful nodes

Malignant: Painless, indurated and fixed to surrounding tissue
Submental lymph node
Mets squamous cell CA in the floor of mouth
Head/neck tumors

Hodgkin's lymphoma
Left side supraclavicular
Vichow's node
R supraclavicular

Mets lung and esophageal
Hodgkins (Nodular sclerosing)

T cell lymphoblastic lymphoma
Testicular CA

Burkitt's lymphoma
Causes of REACTIVE follicular hyperplasia
B-cell antigenic response found in early HIV infection & SLE
Causes of REACTIVE paracortical hyperplasia
T-cell antigenic response found in response to phenytoin and viral infection
Causes of REACTIVE mixed B and T cell hyperplasia
Diagnostic for Cat-scratch disease due to Bartonella henselae

Granulomatous microabscesses in regional lymph nodes
What are the main categories of NHL
B cell (80%)
T cell
List the Types of B cell NHL
1. Small cell
a. Small lymphoctyic lymphoma
b. Follicular lymphoma
2. Medium cell
a. Mantle cell
3. Large Cell
a. Diffuse large cell
4. Burkitt's
5. MALT (extranodal marginal zone)
What doe all lymphomas (Hodgkins and NHL) stain for?

What do T cell NHL stain for?

What do all B cell NHL stain for


Characteristics of Small lymphocytic lymphoma
>60 y.o
Proliferation centers in the lymph node a pathognomonic for SLL
NOTE: CLL if leukemic pahse is present
Characteristics of follicular cell lymphoma
MC form of NHL in US
t(14;18) causing BCL-2 oncogene overexpression
Buttock cells
Characteristics of Mantle cell lymphoma
t(11;14) translocation, BCL-1 oncogene
Characteristics of Diffuse large cell lymphoma
Elderly and childhood
Large cells
May present at extranodal sites: CNS, stomach
Some are associated with HHV-8 and EBV
Characteristics of Burkitt's lymphoma
EBV relationship with t(8;14)translocation

Starry sky appearance of neoplastic B cells and (dark night) and macrpophages (stars)

African type:
Involvment of mandible and maxilla

American type:
GI tract, para-aortic nodes
Characteristics of MALT lymphoma
H. pylori
low grade lymphoma of the stomach
What are the T cell NHL?
1. Precursor T cell lymphoma
2. Precursor T cell lymphoblastic leukemia
3. Mycosis fungoides
4. Sezary syndrome
Characteristics of Mycosis fungoides

Neoplasm of CD4 Th cells

Begins in the skin (rash - plaque - nodular mass)
Characteristics of Sezary syndrome

Neoplasm of CD4Th cells
Mycosis fungoides with a leukemic pahse
Circulating Sezary cells (prominent nuclear cleft)
Types of Hodgkins lymphoma
1. Lymphocytes predominant
2. Mixed cellularity
3. Nodular sclerosing
Characteristics of Lymphocyte predominant
5% of cases
Asx young Males with cervical or supraclavicular node enlargement
Mostly composed of lymphocytes
L-H cells (popcorn cells)
Characteristics of Mixed cellularity
30% of cases
Men >50
Strong EBV association
Numerous RS cells (multilobed cell with prominent nucleoli surrounded by clear space)
CD15+, CD30+ (b/c RS cells)
Eosinophils and plasma cells
Characteristics of Nodular sclerosing
60% of cases
Females, younger
Colagen separates nodular areas
Lacunar cells are present
Some RS cells
CD15+, CD30+
Anterior mediastinal mass + single group of nodes above diaphragm