Flashcards in 3.27.14 TBL Deck (20):
when is allogenic transplant effective
AML and ALL
When is autologous transplant effective
Hodgkins and myeloma,
Patient taking imatinib begins to have increase in BCR-ABL for CML? What is the next effective treatment?
b. autologous transplant
c. allogenic transplant
d. bone marrow bone biopsy, targeting DNA sequencing
Male patient with normal Hgb, normal platelets, 90% mature lymphocytes (normal usually 10%). What history questions would be important?
a. fatigue or SOB
b. fever or night sweats (good for malignancy)
c. weight loss
d. past CBC (to see changes)
e. stomach discomfort (due to splenomegaly)
Male patient with normal Hgb, normal platelets, 90% mature lymphocytes (normal usually 10%). Lymphadenopathy is found. what are the tests that you would do?
b. LDH/uric acid
d. CT scan
Cancers by age
0-14 years of age ALL most common
15-39 years of age AML myeloblasts with auer rods
40-59 AML and CML separate via BM
60 and over CLL (most common overall leukemia, regardless of age)
How do you tell if a lymphoproliferative disorder is chronic or acute?
BM blasts20% is acute
Male patient with normal Hgb, normal platelets, 90% mature lymphocytes (normal usually 10%). Lymphadenopathy is found. You see smudge cells. What other abnormalities may be present
a. prolymphocytes in PBS (not really seen in other cancers) CLL usually has 10-20% prolymphocytes in acute, less than that is more chronic and managable.
if most of the reactive lymphocytes are the same size/shape as RBC, is probably acute/chronic?
chronic; lots of bigger lymphocytes is more acute.
immunophenotype of CLL
CD5, CD23, CD20, lambda or kappa
What is the difference between CLL and MCL immunophenotype?
*Look up staging for CLL:
What is the worst genetic marker for CLL?
deletion of 17p (p53)
Three years later, the CLL presents with SOB and easy fatigue for last three monts. Lymphadenoapthy is prominent and splenomegaly. HIgh EBC with 96% lymphocytes. Hg is 8.2, Hct is 25%. Normal platelets.
Be thinking autoimmune hemolytic anemia (DAT, LDH, reticulocytes). Haptoglobin can be reduced if binding Hgb in the blood.
What do you see in a patient with autoimmune hemolytic anemia?
spherocytes. Ab bind on and macrophages eat off some of the membrane, concentrating the Hgb in a smaller spherical cell.
What can cause microspherocytes
a. autoimmune hemolytic anemia
b. someone with chronic anemia who is transfused, microspherocytes could be transfused RBCs
bad cells infiltrate the marrow. Can cause anemia and increased reticulocyte count in the blood.
what would you do for a CLL patient with autoimmune hemolytic anemia?
b. IV Ig
c. (maybe splenectomy)
Hematologists do not do chemo until bone marrow is infiltrated.
what causes a vesicular lesion?
shingles (herpes zoster) due to severe immunosupression causing reactivation. Should have had the vaccination...