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Last Leg > Hemat Patho > Flashcards

Hemat Patho Flashcards

1
Q

BM exam

A
  • BM aspirate

- BM Bx ( more representative , more painful)

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2
Q

indications of BM Bx

A
  • dry tap
  • assess bm cellularity (100 - age)
  • assess mets in marrow
  • lymphoma staging ( marrow + stage 4)
  • MPN
  • Storage dis (gaucher)
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3
Q

dry tap

A
  • aplastic anemia <25% HSC cells BM
  • myelofibrosis
  • hairy cell leukemia (honey comb, fried egg)
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4
Q

oncohemat classfn

A 
MPN
MP/MDS
MDS
AL
Lymphomas
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5
Q

Acute leukemia Dx

A

> 20% BLASTS (2.5-3 times RBC size)

either PS or BM

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6
Q

mc AUER rods
mod amt cytoplasm
cyto granules +
multiple nuclei

A

Myeloblasts

AML

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7
Q

MPO +

SBB +

A

AML myeloblasts

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8
Q

NSE +

A

monoblasts

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9
Q

TRAP +

A

hairy cell leukemia

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10
Q

scant rim cyto
absent granules
single nucleus
BLOCK + PAS

A

ALL

lymphoblasts

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11
Q

immunophenotyping by?

A

flow cytometry

streamlining cells in single linear flow

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12
Q

mc blue laser 488nm

  • side scatter
  • fwd scatter
A
  • side scatter = granules NEUTROPHILS

- fwd scatter = size BLASTS

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13
Q

Characteristic of BM sample

A

mekakaryocyte

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14
Q

CD 19
CD 3
CD 34

A

CD 19 B CELL
CD 3 T CELL
CD 34 BLAST

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15
Q 
B cell markers 
19
20
10
22, 79a
A

19 PAN B
20 MATURE B
10 IMMATURE B
22, 79a OTHERS

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16
Q

T cell markers
3
4,8,2,5,7

A

thymus schooling — cyto shows APC

Pan - 3

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17
Q

myeloid markers

  • specific
  • myeloid ass
A
  • specific MPO

- myeloid ass CD 13,33,117

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18
Q

NK cell

A

16

56

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19
Q

monocytes

A

4

64

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20
Q

stem cells

A

34
99
TdT (terminal deoxytransferase)

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21
Q

Pan LEUCOCYTE

A

45

LCA

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22
Q

AL

A

AML
ALL (B&T)
MPAL (mixed pheno AL)

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23
Q

best marker to diff hematolymphoid ca vs mets

A

45

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24
Q

MPAL types

A

BALL + AML mc
TALL + AML
BALL + TALL
BALL + TALL + AML all 3 = triphenotypic RAREST

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25
Q

MPN

A 
CML
PV
ET
PMF
CEL (eosinophilic)
CNL (neutrophilic)
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26
Q

high TLC
shift to left ( immature myeloid in PS)
ass with BASOPHILIA
normal myeloid maturation

A

CML

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27
Q

CML vs AL

A

CML - blasts + PM + M + Band

AL = only 90% BLASTS

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28
Q

TLC > 1 lakh
blasts +
LAP score LOW (0-4)

A

CML

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29
Q

TLC < 1 lac
absent blasts
HIGH LAP (400)

A

Leukemoid reacn

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30
Q

normal LAP

A

80-130

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31
Q

low LAP causes

A

CML

PNH

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32
Q

HIGH LAP causes

A

leukamoid reacn
HODGKINS
PV (HIGHEST overall)
CML in blast crisis

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33
Q

stages of CML

A
  • chronic (blasts <10%)
  • accelerated (10-19%)
  • blastic crisis
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34
Q

10-19% blasts
platelet <1lac or >10lac
basophilia >20%

A

1/3 Dx accelerated CML

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35
Q

> 20% blasts

presence of extramed disease

A

CML blast crisis

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36
Q

mc phase where CML detected

A

chronic phase

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37
Q

Dx hallmark of CML

A

fusiion trascript BCR-ABL by PCR (higher specificity and sens than conventional karyo/cytogenetics) for Ph Ch

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38
Q

BCR

ABL

A

22

9

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39
Q

bcr-abl Px
p190
p210
p230

A

p190 POOR BALL
p210 GOOD :) mc CML, AML
p230

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40
Q

hypercellular marrow + predom myeloid lineage

A

BM in CML
M:E HIGH
normal M:E = 3-15:1

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41
Q

dis of firsts?

A

CML

  • 1st to fusion transcript
  • 1st targetted gene Rx
  • 1st recurrent cytogenetic abN detected
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42
Q

criteria for complete hemat remission in CML

A
  • TLC normal
  • NO immature cell in PS
  • baso <5%
  • platelet Normal counts
  • absent extramedullary dis
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43
Q

most sig Prognostic marker in CML

A

MMR

major mol remission = real time PCR/q PCR

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44
Q 
high Hb 
reactive causes of erythrocytosis ruled out 
low S. EPO 
clonal mutation + 
BM hypercellular PANMYELOSIS
A

PV

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45
Q

reactive causes of erythrocytosis

A 
HIGH EPO 
smoking
high alt
copd
athelete
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46
Q

PV mutation mc

also in ET and PMF

A

JAK 2 V 617 F

valine to Phenylalanine

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47
Q

PC > 4.5 lac
reactive causes of thrombocytosis r/o
clonal mutations

A

ET

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48
Q

reactive causes of thrombocytosis

A

IDA

infections

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49
Q

ET Mutation

A
  • JAK 2 same

- MPL mutation

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50
Q

fibrosis of marrow NOT A PREREQUISITE

tear drop cell

A

PMF

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51
Q

stages of PMF

A
  • cellular phase : hyper cellular and dysplastic megakaryocytes
  • fibrotic phase
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52
Q

IOC MPN

A

BM Biopsy

not cytogene/PCR/etc

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53
Q

all are useful in MPN except

A

flow cytometry

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54
Q

pt with CHLOROMAS next best step

A

PS
- AML
_ CML

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55
Q

MPN/MDS types

A
  • atypical CML
  • CMML
  • JMML (HbF high)
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56
Q 
high TLC + shift to left 
bcrabl -ve
elderly 
blasts not raised 
no basophilia
A

atypical CML

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57
Q

monocytes raised in PS > 1000
bcr abl -ve
HbF +

A

CMML or JMML

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58
Q

ps pancytopenia
- hypocellular BM (aplastic anemia <25%)
- hyper cellular BM
mc adults

A

MDS

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59
Q

hypocellular BM (aplastic anemia <25%)

A

MDS

PNH

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60
Q

megaloblastic anemia
infections
auoimmune

A

hypercellular in MDS
PNH
M/C

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61
Q

PNH usually progresses to?

A

aplastic anemia

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62
Q

lap score when AA progresses to PNH?

A

decreases

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63
Q

all are preleukemic except

PCH!

A
  • pnh
  • mds
  • aa
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64
Q

AA can progress to all except

- PRCA

A
  • pnh
  • mds
  • aml
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65
Q

AA can become PRCA?

A

NO

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66
Q

MDS types

A 
RCUD
RCMD
RARS
RAEB
MDS + isolated 5q del
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67
Q

refractory cytopenias

A

MDS

do not respond to usual Rx

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68
Q

abN in 1 lineage RBC

  • ref anemia
  • ref leucopenia
  • ref thrombocytopenia
A

> 10% of 1 lineage is AbN
RCUD
ref cytopenia f unilineage dysplasia

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69
Q

> 1 lineage affected

> 10% of each cell line abN

A

RCMD

ref cytopenia of multilineage dysplasia

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70
Q

erythroid
stains + PRUSSIAN BLUE (PEARLS stain)
>15% erythroid cells RINGED SIDEROBLASTS

A

RARS

ref anemia with ringed sideroblasts

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71
Q

PS vs BM
<5% 5-9%
5-19% 10-19%

A

RAEB 1
RAEB 2
ref anemia with excess blasts

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72
Q

mc cytogenetic abN in MDS
good px
PS - thrombocytosis

A

MDS with isolated 5q del

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73
Q

mc cytogenetic abN MDS overall

A

5q del

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74
Q

mc cytogenetic abN MDS adults

A

5q del

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75
Q

mc cytogenetic abN MDS children

A

monosomy 17

POOR PROGNOSIS

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76
Q

ALL
B
T

A

BALL mc 85-90%

TALL 10-15%

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77
Q

BALL good Px

A

1-10y
t(12,21)
HYPER diploidy

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78
Q

BALL poor Px

A 
high TLC 
high blasts %
LN +
HSM
<1y or >10y 
males testis+
CNS +
t(9;22) p190 bcr abl 
infantile leukemia 
hypodiploidy
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79
Q

infantile leukemia

A

mc t(4;11)

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80
Q

ALL FAB classfn

A

L1 same size of blasts POORER PX
L2 varying sizes
L3 BURKITTS

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81
Q

Most sig Px marker in ALL

A

minimal residual dis

Assess chemoRx response

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82
Q

AML types

A

M0-7

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83
Q

mc AML

lc AML

A

mc - M2

lc - M7

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84
Q

M7

A

acute megakaryocytic
CD 41
61

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85
Q

MPO -ve AML

A

M0, 6, 7

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86
Q

M6

A

acute ERYTHROLEUKEMIC
CD 36, 71
glycophorin A +ve

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87
Q

best Px AML

A

M3

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88
Q

M3

A

acute promyelocytic
mc t(15;17)
PML RARA
CVS # - NBTE

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89
Q

PML RARA Rx

A

ATRA
all trans retinoic acid
mc COD - DIC

90
Q

DIC mc in which AML

A

M3

91
Q

M4

A

acute myelomonocytic

92
Q

M5

A

acute mnocytic

93
Q

NSE +ve
CD 14
16

A

monocytic leukemias

M4&5

94
Q

mc leukemia ass with DOWNS

A

ALL - M7

95
Q

mc AML ass with

  • chloromas
  • BM fibrosis
  • leukemia cutis
A
  • chloromas 2
  • BM fibrosis 7
  • leukemia cutis 5
96
Q

good Px in AML

A

t(15;17) PML RARA M3
t(8;21) AML ETO/RUNX1- RUNXITI M2
inv 16 M4eo

97
Q

16% of blasts in BM which are

  • AML ETO+ve
  • AML ETO -ve
A
  • AML ETO+ve M2

- AML ETO -ve MDS RAEB2

98
Q

hodkins mc REAL WHO classfn

A
  • classical

- lymphocyte predom

99
Q

mixed cellularity mc INDIA
nodular sclerosis mc WEST mc females
lymphocyte rich
L depleted WORST Px

A

classical hodgkins

100
Q

best Px hodgkins

A

lymphocyte predominant hodgins

101
Q

RS reed steenberg cells in reactive background

OWL EYE ap

A

PS of hodgkins

102
Q

CD 15
30
except in lymphocyte predom?

A

Hodgkins

lymphocyte predom = 15- , 30- , 20+

103
Q

variant of RS cells

A
  • popcorn

- lacunar

104
Q

L&H cell

A

popcorn cell
lymphocyte and histiocytic cell
LYPMPHO PREDOM

105
Q

lacunar cell

A

Nodular sclerosis

106
Q

HL shows bomodal age

A
  • young

- >45y

107
Q

Ann arbor

A

HL

  1. single LN
  2. > 1LN same side of diaph
  3. > 1LN on opp side of diaph
  4. BM +
108
Q

mc NHL

A

B NHL MATURE

109
Q
  • SLL/CLL
  • Follicular lymphoma
  • mantle cell lymphoma
  • marginal cell lymphoma
A

mature B NHL

CD 19+ve

110
Q

5+ , 23+ , 200+

19+

A

small lymphocytic lymphoma
chronic lymphocytic lymphoma
SLL /CLL

111
Q

5- , 10+
mc t(14;18)
bcl2+

A

follicular lymphoma

112
Q

5+, 10-, 23-
mc t(11,14) bcl 1+
cyclin D1 +ve

A

mantle cell lymphoma

113
Q

cyclin D1 -ve Mantle

A

SOX 11 +ve

114
Q

5-, 10-

A

marginal cell lymphoma

115
Q

mc NS

  • adults
  • > 40y
A
  • adults FSGS

- >40y MGN (west - FSGS only)

116
Q

mc NHL in INDIA

A

DLBCL
bcl 6 +ve
(west - follicular)

117
Q

mc HL ass with EBV

A

mixed cellularity

118
Q

mc EBV -ve HL

A

lymphocyte predom

119
Q

mc HL with HIV

A

lypmphocyte depleted HL increased incidence BUT

mc - MIXED CELLULARITY

120
Q

high TLC with mature ap lymphocytes
smudge cells mc
characteristic RBC (SPHAEROCYTES - warm AIHA)

A

SLL/CLL

121
Q

Px markers of SLL/CLL

GOOD

A
  • IgVH hypermutation (PCR)
    surrogate: ZAP 70 protein expression
  • ZAP 70 +ve BAD
  • mc cytogenetics - NORMAL
    mc cyto abN del 13q GOOD
  • BAD Px if Del in 11 and 17
122
Q

burkitt types

A
  • african
  • non endemic or sporadia
  • hiv
123
Q

80-90% ebv +
mc mandible
mc t(8;14)
others (2;8) and (8;22)

A

african or endemic burkitt

124
Q

20-30% ebv
ileocecal region
c myc protoonc mutation

A

non endemic burkitt

125
Q

30-40% ebv
LN +
n myc ass with neuroblastoma

A

HIV ass burkitt

126
Q

classical triad
19+
34-
sIgM +

A

mature B cell neoplasm

127
Q

starry sky LN

A

stars - macrophages

sky - burkitt cells

128
Q

large cells with blue cyto
baso cyto
cyto vacuoles

A

PS and BMA in burkitts

129
Q
  • inc PLASMA with any 1 of CRAB
  • plasma >60% in absence of CRAB
  • mc IgG IL 6 overexpression
  • M band on electrophoresis
  • large cell with eccentric nucleus
  • PS: roloulaux STACK OF COINS, >20% plasma cells
A

MM

130
Q

normal MCV

A

80-100

131
Q

immature RBC in PS

indicator of marrow erythropoesis

A

Reticulocyts

Normal - 0.5 - 2.5%

132
Q

supravital stain
mc methylene blue
brilliant cresyl blue

A

retic

133
Q

CRC

A

Retic count x Hb of pt / normal Hb

134
Q

low retic count

A
  • aplastic anemia
  • nutritional anemia
  • CKD
  • ACD
  • Myelofibrosis
135
Q

high retic

A
  • hemolytic anemia

- nutritional anemia on Rx PEAKS ON DAY 7

136
Q

microcytic hypochromic

A
  • IDA mc
  • thal
    sideroblastic
  • ACD rarely
137
Q

nromocytic normochromic

A 
HIGH retic - hemolytic anemia 
LOW retic - 
1. aplastic 
2. ACD
3. CKD
4. myelofibrosis
138
Q

macrocytic

A

megaloblastic 9+12

non megalo - liver dis

139
Q

mc cause of anemia in hosp pt

A

ACD

140
Q

mc anemia in ACD

A

normocytic normochromic

141
Q

nucleo cyto async

A

megalo
nucleus - immature
cyto - mature
MYELOCYTES & METAMYELOCYTES

142
Q

orthochromatic Hb

A

intermediate normoblast

143
Q

1st feature on PS in megalo

A

HS neutrophil

  • > 5lobes in 1
  • 5 lobes in 5%
144
Q

anemia classfn on etiology

A
  • blood loss
  • hemolysis
  • dec prodn
145
Q

hemolytic anemia causes

A
  • HS mc memb# AD
  • G6PD mc enz# XR
  • Hb pathies
146
Q

Hb pathies

A
  • sickle cell AR
  • thal AR
  • PNH acquired
  • autoimmune hemolytic acquired
147
Q

dec prodn of rbc

A 
nutrition
ACD
CKD
MF
AA
148
Q

AD

mc rbc memb# ANKYRIN

A

HS

149
Q 
transmemb anion transporter (BAND3)
protein 4.2 (PALLIDIN)
ankyrin 
beta spectrin
alpha spectrin
A

outer
to
inner

150
Q

HS most severe defect

A

ALPHA SPECTRIN

151
Q

reduced deformability by sphaerocyte
splenic entrapment
HEMOLYSIS extravas

A

HS

152
Q

RBC + vary conc NS

A

osmotic fragility testing

- SHIFT TO RIGHT in normal signmoid curve

153
Q

osmotic fragility testing

- SHIFT TO RIGHT

A

HS

AIHA

154
Q

osmotic fragility testing

- SHIFT TO LEFT

A

SICKLE CELL
IDA
THAL

155
Q 
oxidative damage to globin chain 
chain ppts in RBC 
HEINZ bodies formed
BITE cells 
high retic count
A

G6PD

beingn self limiting

156
Q

site of hemolysis in g6pd

A

intra and extra vas

157
Q

intra and extra vas

A 
g6pd
sickle cell (spleen)
autoimmune COLD Ab (liver)
158
Q

mc clinically sig variant of gdpd def

A

mediterranean type
most severe
low t1/2

159
Q

g6pd test

A

methHb reduction test

160
Q

point mutation in 6th codon of beta chain
Glu acid —> Valine
polymer on deO2
Irreversibly sickled later

A

sickle cell anemia

161
Q

vaso occlusive crisis
splenic changes +
inc risk of infections
aplastic crisis

A

sickle cell anemia

162
Q 
dactilitis of bones of hand and feet 
stroke 
retinopathy 
conj vessels COMMA SIGN 
priapism
A

vaso occlusive crisis

163
Q

splenic changes + sickle cell

A

1st change - spleen enlarged
multiple ifarcts
autosplenectomy

164
Q

H influenza
Strep pneumonia
mc OM in sicle cell - salmonella

A

inc risk of infections

165
Q

SPLENECTOMY INDICATED in
HS?
Sickle cell?

A

HS YES!

Sickle cell NOOO

166
Q

aplastic crisis in sickle cell

A

Parvovirus B 19

erythroid precursor in BM #

167
Q

screening test of choice in sickle cell

A

Hb Electrophoresis

168
Q

IOC for Hb pathies

A

HPLC

- quantitative test

169
Q

normal Hb

A

A a2b2: 88-95%
A2 a2d2: 2-3.5%
F a2g2: <1%

170
Q

main indication for HbElecrophoresis

A

screenignof woman by end of 1st trimester for thal minor

171
Q

thal minor HbElectro

A

HbA2 >3.5% (but <8%)

172
Q

run sample on agar
Hb -ve charge
cathode - Sample - A2 - S - F - A - anode

A

HbElecrophoresis

173
Q

Hb migrating to A 2 region

A

A2
C
E mc

174
Q

Hb migrating to S region

A

S
D punjab
G

175
Q

what is motility of S compared to Hb A?

A

reduced

  • size dep
  • charge dep
  • NOT CONC DEPENDENT!
176
Q

dec alpha chains

GENE DELETIONS

A

alpha thal

177
Q

de beta chains

POINT MUTATION

A

beta thal

A decreased, F increased

178
Q

HbH b4

Hb barts g4

A

physio useless

179
Q

AR
Heterozygous MINOR
homozygoous MAJOR

A

beta thal

2 chains

180
Q 
4 chains 
- del 1 chain 
2
3
4
A

1 chain - asymp carrier
2 - thal MINOR
3 - HbH
4 - Hydrops fetalis

181
Q

Mentzer index

A

MCV/
RBC count

13

182
Q

hypochromia f/b microcytosis

A

thal minor

183
Q

microcytosis f/b hypochromia

A

IDA

184
Q

RDW normal

A

11.5-14.5%

185
Q

RDW increases

A

IDA

normal in thal minor!

186
Q

CD 55
DAF decay accelerating factor
stops action of C3 convertase

A

CD 59
MIRL memb inhibitor of reactive lysis
stops MAC c5b-9

187
Q

PNH

A

def of CD 55 and «< 59 (hemolysis)

188
Q 
acq mutation in PIGA gene on X Ch 
def of Gp1 linked anchor protein
A

acq clonal stem cell
NOT AUTOIMMUNE
coombs -ve

189
Q

mc mortality in pnh

A

thrombosis

- unusual sites Portal v, hepativ v , cerebral vein BUDD CHIARI

190
Q

tests for pnh

A
  • hams (acid serum lysis)
  • sucrose lysis ( more sens)
  • mc GEL CARD (red ring NOZRMAL )
  • flow cytometry
  • FLAER fluroscent pro serolysin test (most specific for pnh f/b flow cytometry
191
Q

IgG AIHA

A

warm
may or may not fix complement
37 deg
EXTRAVAS HEMO (SPLEEN)

192
Q

IgM AIHA

A 
cold 
fixes complement 
4 deg 
BOTH EXTRA mc and @liver AND INTRA 
mycoplasma pneumonia +
193
Q

ass with CLL
shift to right
Ag: BAND 3

A

warm AIHA

194
Q

tests for AIHA

A

coombs

  • direct (Ab on RBC surface)
  • indirect
195
Q

pt blood + Anti human globin = agglutintn

A

direct coombs

196
Q

Ab in serum of pt + Sheep rbc + AHG = Agglutn

A

indirect coombs

197
Q

PS with sphaerocyte next inv

A

coombs

198
Q

IgG (exception to rule)
Donath landsteiner Ab
p blod gp Ag

A

PCH

199
Q

burr cells

A

ECHINOCYTES
spicules on rbc - eq size and eq spaced
mc artifact

200
Q

spur cells/ acanthocytes

A

spicules uneq lenth and spaced

LIVER DIS ABETALIPO

201
Q

bite cells

A

g6pd def

202
Q

myelofibrosis

A

tear drop

203
Q

howell jolly

cabot ring

A

megaloblastic anemia
post splenectomy
thal

204
Q

pappenheimer bodies

A

sideroblastic anemia

205
Q

sphaerocyites

A

HS

AIHA

206
Q

most alarming hemolysis

A 
schistocytes 
MAHA 
DIC
HUS - SHIGA TOXIN 0157:H7
TTP - ADAM TS 1 def 
HELLP 
march Hburia 
def of complement factors BHI
prosthetic heart valves
207
Q

manual Platelet count

A

false low due to clumping

208
Q

falciparum RBC
malairae
vivax

A

banana
rbc left
complete rbc destroyed

209
Q

severe anisopoikilo
microhpochromic
target cells
no inc rbc

A

thal MAJOR

210
Q

basophilic stippling

A

Pb poisoning
thal
megalo

211
Q

stages of IDA

A
  1. dec stores
  2. Fe def erythropoeisis
  3. MCHC
212
Q

Stage 1 IDA

A 
BM iron DEC
S ferritin DEC (most sens)
TIBC INC 
S Fe NORMAL
%transferrin sat NORMAL 
PS NCNC
213
Q

Stage 2 IDA

A

S Fe DEC
%transferrin sat DEC
PS NCNC

214
Q

Stage 3 IDA

A

PS MCHC

215
Q

thrombocytosis

A

secondary to IDA

216
Q

megalo

A

most characteristic - pancytopenia

low retic count

217
Q

after rx of megalo

A
  • BM changes become Normal in 24h
  • PC normal in 1 wk
  • last to disappear are HS neutrophils 2 wks
218
Q

mc dis causing ACD

A
  • TB
  • typhoid
  • hiv
  • autoimmune
  • CTD
219
Q

dis NOT ASS with ACD

A
  • CKD anemia
  • anemia in CLD
  • worm infestation
  • any cause of chronic blood loss
220
Q

ACD patho

A
  • inc HEPCIDIN block
  • cytokines and chemokines suppressing erythropoesis
  • reduced rbc survival 60-80 days

Last Leg (9 decks)

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