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Advanced Haematology > Week 4 > Flashcards

Week 4 Flashcards

1
Q

T or F

Chronic Myeloid Leukaemias originate from a single abnormal haemopoetic stem cell.

A

True

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2
Q

Chronic Myeloid leukaemia is from what type of lineage?

A

Granulocyte

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3
Q

What is increased in the presence of a Chronic Myeloid Leukaemia?

A

Increase myeloid cells, Erythrocytes and platelets

Marked myeloid hyperplasia in bone marrow

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4
Q

According to WHO Classification what are the 4 predominant Myeloproliferative neoplasm disorders?

A
  1. Chronic myeloid leukaemia
  2. Polycythemia Vera
  3. Primary myelofibrosis
  4. Essential thrombocythaemia
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5
Q

Chronic myeloid leukemia has a preponderance of immature cells of which granulocyte lineage?

A

neutrophil

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6
Q

List some clinical findings of Chronic Myeloid Leukemia.

A
  • Frequent infections
  • Anaemia
  • Bleeding
  • Splenomegaly
  • Fatigue
  • Abdominal discomfort
  • Weight loss
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7
Q

T-F : Philadelphia chromosome is found on myeloid, monocytic, erythroid, megakaryocytic, B-cells and sometimes T-cell

A

T

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8
Q 
This is a description of the peripheral blood of what type of leukemia?
• High WCC that can exceed 300 x 109/L
• Dramatic left shift
• Promyelocytes, myelocytes, bands
• Occasional blast
• Thrombocytosis is common
• NRBC rare
A

Chronic Myeloid Leukemia

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9
Q

What other abnormal findings are likely with CML?

A
  • High uric acid
  • High cell turnover, breakdown of nucleic acids
  • Secondary gout, uric acid stones in kidneys
  • High lactate dehydrogenase (LDH)
  • Intracellular enzyme
  • Reflects high rate of cell turnover
  • Vascular stasis due to high WCC
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10
Q

List some therapies for CML

A
  • Bone marrow and stem cell transplantation

* Synthetic proteins that bind the abnormal BRC/ABL protein

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11
Q 
ABL = Chromosome \_\_\_
BCR = Chromosome  \_\_\_\_
A

9, 22

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12
Q

Polycythemia vera has Increases in all components of _____ origin in peripheral blood: (3)

A

myeloid
• Erythrocytes
• Granulocytes
• Platelets

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13
Q

Summarise Polycythemia Vera peripheral blood films

A 
Peripheral blood
• Elevated • Hb, RCC, Hct
• Can be elevated
• WCC, Platelet count, Blood film
• Normochromic normocytic
• Normal maturity of leucocytes and platelets
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14
Q

What are the 2 phases of PV?

A

stable phase and spent phase

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15
Q

What are the features of the spent phase of PV?

A
  • Splenomegaly, pancytopenia
  • May develop marrow fibrosis
  • Tear drop poikilocytes
  • Ineffective haematopoiesis
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16
Q

What can be used as a supportive treatment for PV?

A

Phlebotomy

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17
Q

What are some examples of inappropriate erythropoietin production?

A
  • Renal disease e.g. carcinoma

* Tumors e.g. fibromyoma and liver carcinoma

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18
Q

What are some complications associated with PV?

A

15% of patients progress to acute leukaemia.
Some chemotherapy’s can increase risk
phlebotomy may increase risk of thrombosis and bleeding

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19
Q

What are some causes of apparent polycythaemia or pseudopolycythaemia due to plasma
volume contraction
• No change in total RBC mass

A
  • Stress
  • Cigarette smoker or alcohol intake
  • Dehydration
  • Plasma loss
  • E.g. burn injury
20
Q

WHO classification requires 4 major criteria for essential thrombocytosis:

A
  1. PCT > 450 x 109/l
  2. Bone marrow
    • Significant increase in megakaryopoiesis
    • In absence of increase in erythropoiesis, granulopoiesis
    • No left shift in granulocytes
    • Large mature-looking megakaryocytes
  3. Cannot meet the criteria of other neoplasms
  4. Abnormal genetic markers or absence of reactive thrombocytosis
21
Q

Summarise the clinical presentation of essential thrombocythaemia

A

50-60yr olds
Sometimes due to vascular occlusion or bleeding in GI and respiratory tract
50% splenomegaly

22
Q

Increased collagen production in bone marrow with Increase in circulating haemopoietic cells
is

A

Myelofibrosis

23
Q

Usual age of patients diagnosed with Myelofibrosis.

A

• Usually over 60 years

24
Q

What are some possible general presentations of Myelofirbrosis

A
  • Fatigue
  • Weakness
  • Shortness of breath
  • Palpitations
  • Weight loss
  • Discomfort associated with splenomegaly
25
Q

What are some bone marrow features of myelofibrosis?

A
  • Fibrosis
  • Hypercellularity
  • Increased megakaryocytes
  • Enlarged, pleomorphic nuclei
26
Q

What are some peripheral blood features of myelofibrosis?

A
  • Immature granulocytes
  • Normoblasts
  • Teardrop red cells
  • Other bizarre red cell shapes
27
Q

What disease is this describing?
• Heterogeneous collection of haemopoietic stem cell disorders affecting older adults
• Underlying ineffectiveness of haemopoiesis
• Results in dysplasia of bone marrow precursors
• Peripheral cytopaenias
• Acquired clonal disorders with defects in maturation:
• Erythroid
• Myeloid and/or
• Megakaryocyte

A

Myelodysplastic syndrome

28
Q

Myelodysplastic syndrome is haemopoietic stem cell mutation. What are some possible causes of this mutation?

A
  • Radiation
  • Chemical
  • Viral
  • Smoking?
29
Q

List so typical peripheral blood findings in Myelodysplastic syndrome

A
  • Oval macrocytes
  • Hypochromic microcytes
  • Dimorphic blood picture
  • Basophilic stippling
  • RNA
  • Howell-Jolly bodies
  • Abnormal granulation of neutrophils
  • Hypersegmentation Hyposegmentation
  • Nuclear rings
30
Q

List some bone marrow findings in myelodysplastic syndrome

A 
• RBC precursors 
• more than 1 nucleus
• Abnormal nuclear shapes
• Ringed sideroblasts
• Accumulation of iron in peri-nuclear 
mitochondria
• Iron stain
31
Q

What morphology would be expected of platelets in myelodysplastic syndrome?

A
  • Giant platelets
  • Abnormal granulation
  • Circulating megakaryocytes
32
Q

Acute leukaemias have at least _____ % blasts in the BONE MARROW

A

20%

33
Q

List some lab/clinical findings in Acute Lymphoblastic Leukaemias

A
  • Only 50% of patients have leucocytosis
  • Many do not have circulating lymphoblasts
  • Common findings:
  • Anaemia
  • Neutropaenia
  • Thrombocytopaenia
  • What symptoms might you expect?
  • Lymphadenopathy common
  • Splenomegaly, hepatomegaly may be seen
  • Bone pain from invasion of periosteum
  • Malignant cells in meninges, testes, ovaries
34
Q

What are the two major groups of Acute lymphoblastic leukaemia?

A

B lymphoblastic leukaemia

T lymphoblastic leukaemia

35
Q

What are the two morphologic types of Acute lymphoblastic leukaemia?

A

small lymphoblast

large lymphoblast

36
Q

What is the most common leukaemia in children under 1yr old?

A

Acute myeloid leukaemia

37
Q

What is the most common leukaemia in adults?

A

Acute myeloid leukaemia according to slides but the internet says Chronic Lymphocytic Leukaemia is??

38
Q

90% of Acute myeloid leukaemia patients have _______ in their peripheral blood

A

myeloblasts

39
Q

Which leukaemia has auer rods as a characteristic?

A

Acute myeloid leukaemia - • Needle shaped clumps of primary granules

40
Q 
Leukaemia Acute lymphoblastic
Blast size 
Cytoplasm 
Chromatin 
Nucleoli 
Auer rods
A 
Small 
Scant 
Dense 
Indistinct 
No
41
Q 
In Acute myeloid leukaemia describe the below:
Blast size
Cytoplasm
Chromatin
Nucleoli
Auer rods
A 
Large
Moderate
Lacy
Prominent
50% of patients
42
Q

In acute myeloid leukaemia symptoms reflect decreased production of normal marrow elements - list some

A
  • Anaemia
  • Neutropenia
  • Thrombocytopenia
  • DIC
  • Infiltration of malignant cells into gums, mucosa, skin
43
Q

A metabolic complication of malignancy that invovled the breakdown products of dying tumour cells is called

A

Tumour lysis syndrome

44
Q

What is the difference between secondary polycythaemia and relative polycythaemia?

A

Relative polycythaemia - caused by smoking, stress,dehydration, plasma loss
Secondary polycythaemia - is polycythaemia secondary to:
• Renal disease e.g. carcinoma
• Tumors e.g. fibromyoma and liver carcinoma

45
Q

What could cause a ‘normal’ compensatory increase in erythropoietin

A
  • High altitude
  • Pulmonary diseases
  • Heart diseases eg- cyanotic heart disease
  • Abnormal hemoglobin- High affinity Hb
  • Heavy cigarette smoker
46
Q

Outline the cause of and lab findings in tumour lysis syndrome

A 
Increase in 
Uric acid
Potassium
Phosphorous
Decrease in 
Calcium

Advanced Haematology (13 decks)

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