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73 Cards in this Set
- Front
- Back
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Leukemoid rxn
Etiology |
Benign, Elevated leukocytes count response to infection
Perforating appendix (PMNs) Whooping cough (lymphocyte) Cutaneous larva migrans (eosin) |
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In what pts to you find a leukoerythroblastic rxn
Blood findings |
Women > 50 associated with metastatic breast CA
Peripheral blood: Myeloblasts Nuleated RBCs and tear drop RBCs |
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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 |
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Causes of neutropenia
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1. Aplastic anemia
2. Septic shock 3. SLE - immune destruction |
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Job's syndrome
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AR
Disorder of neutrophils, charcaterized by abn chemotaxis leading to COLD soft tissue abscess due to Staph aureus. Red hair, leonine face, eczema, incr IgE |
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Causes of eosinophilia
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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 |
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Causes of esosinopenia
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1. Hypercortisolism - Cushing's
2. CS - Sequester eosin in lymph nodes |
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Causes of monocytosis
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1. Chronic Infection - TB
2. AI - SLE, IBD 3. malignancy |
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Causes (4) of lymphocytosis
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1. Viral infection
2. Bacterial - B. pertussis ( produces lymphocyte-promoting factor 3. Drugs - phenytoin 4. Graves Dz |
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Causes of atypical lymphocytosis
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1. Infection - Mono, hepatitis, CMV, toxo
2. Drugs - Phenytoin |
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Pathogenesis of IM
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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
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DF of atypical lymphocyte
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Antigenically stimulated CD8 T cells
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Lab and clinical findings suggestive of IM
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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 |
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Causes of lymphopenia
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1. HIV
2. DiGeorge, SCID 3. SLE - immune destruction 4. CS 5. Radiation - lymphocytes are most sensitive to destruction by radiation |
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What type of hematologic findings are associated with CS use
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Neutrophilic leukocytosis (neutrophilia)
Eosinopenia and lymphopenia |
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Pt presenting with Fever, sore throat, post. auricular lympaditis is Tx with an abx and develops a rash
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Ampicillin
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T cell area of the lymph node?
B cell rich region of the lymph node? |
Paracortex (T cell rich)
Primay follicle (B cell rich) |
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Leukemias by age grp and cell type of each
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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 |
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General findings in Leukemias
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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) |
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Presentation of Acute VS. Chronic Leukemia
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Acute:
1. Abrupt onset of fever, fatigue, bleeding 2. Bone pain and tenderness - expansion by leukemic cells 3. Hypercellular bone marrow Blasts > 20% Chronic: 1. Insidious onset 2. Hypercellular bone marrow, <10% blasts Both: 1. Hepatosplenomegaly 2. General lymphadenopathy |
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What are the 3 categories (subcategories) of myeloproliferative disorders
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1. Myelodysplastic syndrome
2. AML 3. Chronic myeloproliferative Disorders a. PCV b. CML c. Myeloid metaplasia w/myelofibrosis d. ET |
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Myelodysplastic syndrome
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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 |
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AML
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15-60 yo
M0 - M7 |
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MO:
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Undifferentiated
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M1:
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Myeloblastic leukemia w/o differentiation
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M2:
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Myeloblastic leukemia w/maturation (some promyelocytes)
Auer rods MC type (30-40%) of cases |
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M3:
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Acute promyelocytic
DIC present (Tx can release auer rods - DIC) t(15;17) translocation Tx contains trans-retinoic scid |
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Auer rods
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Seen in M2 M3 (MC)
Peroxidase-positive (MPO) cytoplasmic inclusion in myeloblasts |
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M4:
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Acute myelomonocytic (has both myeloblasts and monoblasts)
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M5:
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Acute Monocytic leukemia
Infiltrates gums |
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M6:
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Acute erythroleukemia
Multinucleated erythroblasts |
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M7:
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Acute megakaryocytic
Myelofibrosis in bone marrow Down syndrome children <3 |
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CML
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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 |
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CML Tx
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Hydroxyurea to control
Bone marrow transplant |
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Lab findings in PCV
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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) |
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Clinical finding and sequalae of PCV
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Signs of increased histamine - Red face, pruritis after bathing, PUD
DVT, hyperuricemia / gout Increased risk for acute leukemia |
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Lab findings and Ex of relative Polycythemia
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Hb, Hct, RBC count Incr
RBC Mass: Nml Plasma volume: Decr Sao2: Nml EPO: Nml EX: Volume depletion |
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Lab findings and Ex of Appropriate Polycythemia
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Hb, Hct, RBC count Incr
RBC Mass: Incr Plasma volume: Nml Sao2: Decr EPO:Incr EX: COPD, cyanotic congenital heart Dz |
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Lab findings and Ex of inappropriate Polycythemia
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Hb, Hct, RBC count Incr
RBC Mass:Incr Plasma volume: Nml Sao2: Nml EPO: Incr EX: Ectopic Epo - Renal Dz |
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ET
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Incr platelets, but are nonfunctional
Present with bleeding, mild neutrophilic leukocytosis, splenomegaly |
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Myelofibrosis and myeloid metaplasia
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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 |
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What are the 4 types of lymphoid leukemia
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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) |
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ALL Pre-B type
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Newborn - 14 y.o
CD10 +, TdT (deoxynucleotidyl transferase) + >20% lymphoblasts in peripheral blood Bone marrow replaced by lymphoblasts Normocytic anemia Thrombocytopenia Commonly mets to CNS and testes (sanctuary sites) |
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ALL T-cell
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Newborn - 14 y.o
CD10 - TdT + Mediastinal mass in young adolescents >20% lymphoblasts in peripheral blood Bone marrow replaced by lymphoblasts Normocytic anemia Thrombocytopenia |
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CLL
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> 60 y.o
Virgin B cell leukemia MCC of general lymphadema in >60 Hypogammaglobulinemia 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) |
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Adult T cell
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HTLV-1 association
CD4 + TdT - Skin infiltration Lytic bone lesions with hypercalcemia Hyperlobulated 4-leaf clover lymphocytes in peripheral blood >20% lymphoblasts Normocytoc anemia Thrombocytopenia |
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Hairy cell
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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 |
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Clinical presentation differentiating Benign from Malignant lymphadenopathy
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Inflammation (Benign): Painful nodes
Malignant: Painless, indurated and fixed to surrounding tissue |
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Submental lymph node
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Mets squamous cell CA in the floor of mouth
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Cervical
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Head/neck tumors
Hodgkin's lymphoma |
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Left side supraclavicular
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Vichow's node
Gastric pancreatic |
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R supraclavicular
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Hodgkins
Mets lung and esophageal |
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Mediastinal
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Hodgkins (Nodular sclerosing)
T cell lymphoblastic lymphoma |
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Para-aortic
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Testicular CA
Burkitt's lymphoma |
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Causes of REACTIVE follicular hyperplasia
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B-cell antigenic response found in early HIV infection & SLE
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Causes of REACTIVE paracortical hyperplasia
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T-cell antigenic response found in response to phenytoin and viral infection
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Causes of REACTIVE mixed B and T cell hyperplasia
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Diagnostic for Cat-scratch disease due to Bartonella henselae
Granulomatous microabscesses in regional lymph nodes |
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What are the main categories of NHL
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B cell (80%)
T cell |
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List the Types of B cell NHL
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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) |
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What doe all lymphomas (Hodgkins and NHL) stain for?
What do T cell NHL stain for? What do all B cell NHL stain for |
LCA+
UCHL-1+ CD20+ |
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Characteristics of Small lymphocytic lymphoma
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>60 y.o
CD23+ CD10- Proliferation centers in the lymph node a pathognomonic for SLL NOTE: CLL if leukemic pahse is present |
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Characteristics of follicular cell lymphoma
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MC form of NHL in US
Elderly CD10+ CD5- t(14;18) causing BCL-2 oncogene overexpression Buttock cells |
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Characteristics of Mantle cell lymphoma
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CD5+
CD10- t(11;14) translocation, BCL-1 oncogene |
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Characteristics of Diffuse large cell lymphoma
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Elderly and childhood
Large cells Agressive May present at extranodal sites: CNS, stomach Some are associated with HHV-8 and EBV |
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Characteristics of Burkitt's lymphoma
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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 |
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Characteristics of MALT lymphoma
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H. pylori
low grade lymphoma of the stomach |
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What are the T cell NHL?
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1. Precursor T cell lymphoma
2. Precursor T cell lymphoblastic leukemia 3. Mycosis fungoides 4. Sezary syndrome |
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Characteristics of Mycosis fungoides
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40-60
Neoplasm of CD4 Th cells Begins in the skin (rash - plaque - nodular mass) |
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Characteristics of Sezary syndrome
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40-60
Neoplasm of CD4Th cells Mycosis fungoides with a leukemic pahse Circulating Sezary cells (prominent nuclear cleft) |
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Types of Hodgkins lymphoma
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1. Lymphocytes predominant
2. Mixed cellularity 3. Nodular sclerosing |
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Characteristics of Lymphocyte predominant
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5% of cases
Asx young Males with cervical or supraclavicular node enlargement Mostly composed of lymphocytes L-H cells (popcorn cells) CD15- CD30- |
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Characteristics of Mixed cellularity
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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 |
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Characteristics of Nodular sclerosing
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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 |
