3RD HEMA - Part 2 Flashcards
(145 cards)
1
Q
Overproduction of various types of immature or mature cells in the bone marrow and/or peripheral blood (in
most types of leukemia)
A
LEUKEMIAS
2
Q
Frequently involves WBCs of the myelogenous or lymphocytic cell types
A
LEUKEMIAS
3
Q
Malignant cells easily trespass the blood-brain barrier
A
LEUKEMIAS
4
Q
Solid malignant tumors of the lymph nodes and related WBCs in the bone
tissue.
A
LYMPHOMAS
5
Q
The distinctive cell type is the lymphocyte.
A
LYMPHOMAS
6
Q
A neoplastic disease characterized by an overproduction of immature or mature cells of various WBC types in the bone marrow or peripheral blood
A
LEUKEMIA
6
Q
Malignant cells are initially confined to the organs containing mononuclear
phagocytic cells such as lymph nodes, spleen, liver, and bone marrow.
Lymphomas can spill over into the circulating blood and demonstrate a
leukemic-appearing picture on a peripheral blood film.
A
LYMPHOMAS
7
Q
● Bear in mind that other blood cells may also be involved:
- Sometimes affect the megakaryocytic line
- Erythroid line
- Commonly attributed to lymphocytes
A
LEUKEMIA
8
Q
With Leukemia = M:E ratio of
A
10:1
9
Q
Erythroid will become
A
RBC
10
Q
Normal Ratio =
A
2:1 to 4:1
11
Q
Myeloid will become
A
WBC
12
Q
Type of anemia usually present in cases of acute leukemia:
A
Normocytic, Normochromic
13
Q
More blasts: shorter, more fatal course of disease
A
- ↑ WBC count with shift to the left
14
Q
↑ Number of YOUNG forms of WBCs
(usually neutrophils)
A
Shift to the LEFT
15
Q
● Described by symptoms of short duration
A
Acute Leukemias
15
Q
2 kinds of cancer involving the WBC
A
○ Leukemia
○ Lymphoma
15
Q
↑ Number of OLD forms of WBCs
A
Shift to the RIGHT
16
Q
● Numerous immature cell forms in the bone marrow and/or peripheral blood
A
Acute Leukemias
17
Q
● Described by symptoms of long duration
A
Chronic Leukemias
18
Q
● Mostly mature cell forms in the bone
marrow and/or peripheral blood
A
Chronic Leukemias
19
Q
● Total WBC counts range from extremely elevated to lower than
normal
A
Chronic Leukemias
20
Q
● Increased total WBC count
A
Acute Leukemias
21
Q
CLASSIFICATION OF LEUKEMIA: (2) NEW WAY
A
International Consensus Classification (ICC)
World Health Organization (WHO)
21
CLASSIFICATION OF LEUKEMIA: OLD WAY
French American British (FAB)
22
● An old system of classifying leukemia
● Based on
- Morphology of cells in Romanowsky-stained smear
- Cytologic and histochemical characteristics of cells involved
FRENCH-AMERICAN-BRITISH (FAB) CLASSIFICATION OF LEUKEMIA
23
Used in differentiating blasts
of AML from those of ALL
MYELOPEROXIDASE (MPO)
23
Examples of cytochemical stains used in FAB
- Myeloperoxidase (MPO)
- Sudan Black B
24
Enzyme found in primary granules of:
- Neutrophils and Eosinophils
- Monocytes (to a certain extent)
MYELOPEROXIDASE (MPO)
24
(+) Peroxidase stain rules
out ALL
MYELOPEROXIDASE (MPO)
25
Reactions parallel those of the MPO’s (in most cases)
Stains
- Sterols
- neutral fats,
- Phospholipids (found in the primary and secondary granules of neutrophils and lysosomal granules of monocytes)
SUDAN BLACK B (SBB)
26
most sensitive stain for granulocytic precursors
SUDAN BLACK B (SBB)
27
MYELOPEROXIDASE (MPO): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE
● Neutrophilic granules
(except normal blasts)
● Auer rods
● Leukemic blasts in FAB
M1, M2, & M3
● Eosinophils
POSITIVE
28
MYELOPEROXIDASE (MPO): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE
● Monocytes
WEAKLY POSITIVE or NEGATIVE
29
POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE
● Myeloblasts
● Basophils
● Lymphocytic cell series
● Erythrocytic cell series
NEGATIVE
30
SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE
● Promyelocyte,
myelocyte
● Leukemic blasts
● Auer rods
● Eosinophils
POSITIVE
31
SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE
● Metamyelocyte
● Bands
● Segmented neutrophils
STRONGLY POSITIVE
32
SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE
● Myeloblasts
● Monocytic cells
WEAKLY POSITIVE or NEGATIVE
33
SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE
● Lymphocytes and its precursors
● Megakaryocytes and platelets
● Erythrocytes
NEGATIVE
34
● COLOR: Depending on the method, peroxidase positive granules may produce a
- Red-brown
- Dark brown or
- Black color
35
In one method, the RBCs develop diffusely ______ color because of pseudoperoxidase activity in hemoglobin.
brown
36
MYELOPEROXIDASE (MPO) STAINS
- The substrate being used in one of the methods
- A potential carcinogen.
3,3-diaminobenzidine (DAB) tetrahydrochloride
37
- May be used to detect eosinophilic leukemia
- Eosinophilic leukemia is poorly understood.
- The peroxidase activity of eosinophils is different from
that in other granulocytes because of the activity of the enzyme in the presence of sodium cyanide
Cyanide-resistant peroxidase stain
38
is sensitive to light. Smears should be stained immediately or kept in the dark.
Peroxidase enzyme
39
Smears that are older than __ weeks or that have been exposed to excessive light should not be reported as peroxidase negative.
2
40
● Wear protective clothing (including
gloves, lab coat, and mask when weighing out powders.
● For all pipetting, use mechanical aids.
● Clean up spills instantly.
● Wash hands properly after completion.
● Weigh benzidine in hood.
Precautions taken when handling DAB
41
may be performed on a specimen
that is several months old.
Sudan Black B stain
42
Reagents in SBB staining are ___ considered to be carcinogenic.
NOT
43
● Disadvantages of the SBB reaction:
- Time necessary to perform the stain (__ to __ hours)
- False-________ reactions are possible in disorders characterized by cytoplasmic lipid vacuoles (such as Burkitt’s lymphoma and occasionally, acute lymphocytic leukemia)
- ___________ background staining on bone marrow specimens (attributable to the fatty nature of the bone marrow itself)
- Time necessary to perform the stain (1 to 2 hours)
- False-positive reactions are possible in disorders characterized by cytoplasmic lipid vacuoles (such as Burkitt’s lymphoma and occasionally, acute lymphocytic leukemia)
- Increased background staining on bone marrow specimens (attributable to the fatty nature of the bone marrow itself)
44
● Brownish-black cytoplasmic granules are seen in myelocytic precursors.
● Monocytes demonstrate few small brownish-black granules.
● Eosinophilic granules are brown and commonly demonstrate central pallor (granules are positive at their periphery with negative centers).
● Lymphoid cells rarely stain.
Effects of Sudan Black B (SBB)
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LYMPHOCYTIC LEUKEMIA GENERAL RESULT: Myeloperoxidase
NEGATIVE
46
LYMPHOCYTIC LEUKEMIA GENERAL RESULT: Sudan Black B
NEGATIVE
46
Most common form of childhood leukemia
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
47
Patients:
70% of childhood ALL
L1
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● Subtypes of ALL
- ALL L1
- ALL L2
- ALL L3 - “_____________”
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
L3 - Burkitt Type
49
● Classification:
- by FAB → 3 subtypes (L1, L2, L3)
- BY use of immunologic Markers
ACUTE LYMPHOCYTIC LEUKEMIA (ALL)
50
Patients:
70% of adult ALL
L2
51
Patients:
Rare in children and adults
L3
52
Immunologic markers:
CALLA (CD10)
TdT
CD19
CD20
L1
52
Immunologic markers:
TdT
L2
53
Immunologic markers:
sIg
CD19
CD20
CD22
CD24
L3
54
Cell size:
Homogeneous population of
small blasts
L1
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Cell size:
Heterogeneous population of
large blasts
L2
55
Nucleus:
Uniformly round, small
L1
56
Cell size:
Homogeneous population of
large blasts (with nuclear and cytoplasmic vacuoles)
L3
57
Nucleus: Irregular
L2
58
Nucleus:
Round to oval
L3
59
Nucleolus:
Single to
several
L2
60
Nucleolus:
Single
L1
61
Chromatin:
Slightly reticulate with perinucleolar clumping
L1
61
Cytoplasm:
Scant, blue
L1
62
Nucleolus:
Two to five
L3
63
Chromatin:
Coarse with clear parachromatin
L3
63
Chromatin:
Fine
L2
64
Cytoplasm:
Moderate, pale
L2
65
Cytoplasm:
Moderate, blue, prominently
vacuolated
L3
66
Periodic acidSchiff (PAS)
L1 L2 L3
+ + -
67
Methyl Green Pyronine
L1 L2 L3
- - +
68
Oil Red O (ORO)
L1 L2 L3
+ + +
69
L1, L2, L3
Both have TdT
L1 and L2
70
L1, L2, L3
Both have
CD19
CD20
L1 and L3
71
BY USE OF IMMUNOLOGIC MARKERS:
E rosettes - Surface Ig - Serum
Anti-ALL
T-ALL:
+ - -
72
BY USE OF IMMUNOLOGIC MARKERS:
E rosettes - Surface Ig - Serum
Anti-ALL
Null ALL:
- - -
73
BY USE OF IMMUNOLOGIC MARKERS:
E rosettes - Surface Ig - Serum
Anti-ALL
B-ALL:
- + -
74
BY USE OF IMMUNOLOGIC MARKERS:
E rosettes - Surface Ig - Serum
Anti-ALL
Common ALL:
- - +
75
Why is the MPO and SBB still needed?
● You may identify leukemic cells using a Wright stain but you can classify them using MPO and SBB
● In Oil Red O, all are positive but, reactions of L1 and L2 are only SOMETIMES observed.
● L3 is always positive with Oil Red O
76
What particular type of cells have nuclear and cytoplasmic vacuoles?
L3
77
● Manifestations:
- Persistent lymphocytosis
■ The lymphocyte count is always
increased
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
78
● Most common form of Leukemia in the elderly
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
79
- Increased # of Smudge (Nuclear Remnants of Lymphocytes) and Rieder Cells (Lymphocytes w/
cloverleaf-like nucleus)
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
80
● Examples of clinical variations of:
- Hairy Cell Leukemia
- Lymphosarcoma Cell Leukemia
- Prolymphocytic Leukemia
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
80
Reticulum Cell Sarcoma
Monocytic Leukemia
81
Lymphoma, poorly-differentiated;
lymphocytic
Acute Lymphoblastic Leukemia (ALL)
82
Lymphoma, well-differentiated;
lymphocytic
Chronic Lymphocytic Leukemia (CLL)
83
What does the acronym PASS stand for?
Pull, Aim, Squeeze, Sweep
84
Myeloma / Plasma Cell
Myeloma / Multiple Myeloma
Plasma Cell Leukemia
85
Chloroma
Acute myelogenous Granulocytic Leukemia
86
Lymphoma, undifferentiated
Stem Cell Leukemia
87
What is the protein that can be found in patients with Plasma Cell Myeloma?
Bence-Jones Protein
88
NON- LYMPHOCYTIC OR MYELOGENOUS LEUKEMIA
GENERAL RESULT: Myeloperoxidase
POSITIVE
89
NON- LYMPHOCYTIC OR MYELOGENOUS LEUKEMIA
GENERAL RESULT: Sudan Black B
POSITIVE
90
Myelocytic
AML, minimally differentiated
MPO (-)
SBB (-)
M0
91
Myelocytic
AML without maturation
- Demonstrated auer rods which are linear projections of primary
granules
M1
92
Myelocytic AML, with maturation
- Most Common subtype
- Has Auer rods
M2
93
Myelocytic
Acute Promyelocytic Leukemia (APL)
- Faggot Cells (Bundles of auer rods)
- DIC
- Auer Rods
M3
94
Myelocytic
APL, Microgranular Variant
- Cells have the characteristic
“butterfly”, “bowtie”, “coin-on-coin”, or “apple-core nuclei”
M3V
95
Myelocytic
Monocytic
Acute Myelomonocytic Leukemia (AMML)
- Aka Naegeli Monocytic
Leukemia
- 2nd most common subtype of AML
- May demonstrate Auer rods M4E
- “AMML, with increased marrow
eosinophils
M4
96
“AMoL poorly differentiated”
- Seen in children
- Demonstrate >80% monoblasts in the bone marrow
M5a
96
Monocytic
Acute Monocytic Leukemia (AMoL)
- Aka Schilling
Leukemia
M5
97
- “AMML, with increased marrow
eosinophils
M4E
98
“AMoL, well differentiated”
- Seen in middle-aged adults
- Demonstrate <80% monoblasts in the bone marrow
M5b
99
Erythrocytic
Myelocytic
Acute Erythroleukemia
- Aka DiGuglielmo’s Syndrome
- May demonstrate Auer rods
- Type of anemia:
macrocytic, normochromic.
- This deviates from the typical
pattern in which patients with
acute myeloid leukemia (AML)
exhibit normocytic, normochromic anemia.
M6
100
- Among the subtype of AML, it is only M__ that is (+) with Factor VIII stain
M7
100
- Erythroid cells in AML M6 are PAS strongly (+)
- This is significant finding as
erythroid cells are normally PAS (-)
M6
101
Megakaryocytic
Acute Megakaryocytic Leukemia
- It requires immunocytochemical
al staining for accurate diagnosis
- The immunocytochemical
stain referred to is the Factor VIII
stain (+)
M7
102
Acute Basophilic Leukemia
- It is in Rodak’s and Turgeon
- It is not designated as AML
- It less occurring than other (M0 -
M7
M8
103
What is the AML that has no maturation?
M1
104
What is the AML that has maturation?
M2
104
What is the other name of M4?
Naegeli Monocytic Leukemia
105
What is the other name of Acute Monocytic Leukemia (M5)?
Schilling Leukemia
106
How many AML demonstrate the presence of Auer rods?
5 = M1, M2, M3, M4, M6
107
are derived from myelocytic cells, which is why they exhibit positive results for MPO, SSB, and SE.
AML M1-M3
107
The following are Leukemias that are PAS (+)?
ALL - L1
ALL - L2
AML - M6
108
What is the other name of AML M8?
Acute Basophilic Leukemia
109
If myelocytic is the cell origin of leukemias, that kind of leukemia will test positive (+) for - (3)
“Myelocytic” = (+) → MPO, SSB, SE
myeloperoxidase, sudan black b, and specific esterase stain
109
Other name for Acute Erythroleukemia (M6)
DiGuglielmo’s Syndrome
110
Type of anemia for Acute Erythroleukemia (M6)
macrocytic, normochromic
110
If monocytic is the cell origin of leukemias, that kind of leukemia will test positive (+) for - (2)
“Monocytic” = (+) → NSE (Butyrate), NSE (Acetate)
nonspecific butyrate and nonspecific esterase stain
111
● In contrast, they yield negative results for NSE (butyrate) and NSE (esterase) due to the fact that NSE butyrate and esterase are specific to monocytic cells of origin
AML M1-M3
112
● Also known as: Chronic granulocytic leukemia
CHRONIC MYELOGENOUS LEUKEMIA (CML)
112
cell line exhibits myelocytic and monocytic characteristics as its cell of origin. Consequently, it will yield positive results for MPO, SSB, SE, NSE (butyrate), and NSE (acetate).
AML M4
112
= only positive for Factor VIII
M7
113
Characterized by the presence of Philadelphia Chromosome (Ph1)
CHRONIC MYELOGENOUS LEUKEMIA (CML)
114
First described in 1960 by Peter C. Nowell, a faculty member of the University of Pennsylvania,
Philadelphia, as an unfamiliar small chromosome present in the WBCs of patients with CML
Philadelphia Chromosome (Ph1)
114
Due to reciprocal translocation involving the long arms of chromosome 9 and 22 (results in the formation of the BCR-ABL1 fusion gene)
Philadelphia Chromosome (Ph1)
114
● ____ of patients w/ CML have Ph1
○ Presence of Ph1 = ______ prognosis
● 90% of patients w/ CML have Ph1
○ Presence of Ph1 = goods prognosis
115
● Three clinical phases of CHRONIC MYELOGENOUS LEUKEMIA (CML)
-
-
-
- Chronic phase
- Accelerated phase
- Blast crisis
116
CHRONIC MYELOGENOUS LEUKEMIA (CML) Must be differentiated from ___________ (LR)
leukemoid reaction
117
is the likely outcome of a disease
Prognosis
118
Though the presence of Ph1 indicates good prognosis, it is still not 100% good news for the patient because Ph1 chromosome means _______
cancer
118
patient might die of disease, px may not get well leading to death
Poor prognosis
118
patient might survive the disease
Good prognosis
119
Due to reciprocal translocation involving the long
arms of chromosome __ and __ (results in the
formation of the BCR-ABL1 fusion gene)
9 and 22
120
Three clinical phases:
- Chronic phase
- Accelerated phase
- Blast crisis
CHRONIC MYELOGENOUS LEUKEMIA (CML)
121
THE 2022 ____ AND ____ classification of AML
ICC AND WHO
● ICC = International Consensus Classification
● WHO = World Health Organization
