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Acute Leukemias Flashcards

(46 cards)

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1
Q

Acute Leukemias

A

stem cell disorders characterized by malignant neoplastic proliferation & accumulation of immature & nonfunctional hematopoietic cells in the BM

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2
Q

Acute Leukemia General Characteristics

A

Abrupt onset & progresses rapidly
symptoms are related to the anemia, thrombocytopenia &/or neutropenia
BLASTS ARE ALMOST ALWAYS FOUND IN PB
2 categories

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3
Q

AML vs ALL

A

AML- affects the maturation of myeloid stem cells

ALL- affects the lymphoid progenitor

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4
Q

Acute Leukemia FAB criteria

A

morphological & cytochemical evaluation

>30% blasts

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5
Q

Acute Leukemia WHO criteria

A

morphology, cytogenetics, molecular genetics, & immunologic markers
>20% blasts

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6
Q

Acute Lymphoblastic Leukemias

A

malignant lymphocytes that do not mature & do not undergo apoptosis

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7
Q

Epidemiology of ALL

A

L1 - most common leukemia of children

L2 & L3 - seen in children & adults

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8
Q

ALL clinical Findings

A 
normo, normo anemia
thrombocytopenia
bone pain
usually neutropenia
WBC - increased, normal, decreased
LYMPHOBLASTS - no auer rods & scant cytoplasm
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9
Q

ALL BM findings

A

hypercellular

>20% lymphoblasts

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10
Q

ALL stain reactions

A

myeloperoxidase -
sudan black B -
chloroacetate esterase -

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11
Q

ALL L1 General Characteristics

A

most common ALL in children - peak age is 2-6
best prognosis
majority of ALL cases

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12
Q

ALL L1 Morphology

A

lymphoblasts predominantly small (2x mature lymph)
nuclear shape is regular
nucleoli are NOT prominent
cytoplasm is scant & only moderately basophilic

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13
Q

ALL L2 General Characteristics

A

most frequent ALL found in adults

large lymphoblasts

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14
Q

ALL L2 morphology

A

LARGE lymphoblasts
nuclear shape is irregular w/ indentations
nucleoli are large & prominent
cytoplasm size & color is variable

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15
Q

ALL L3 General Characteristics

A

rarest form of ALL
known as BURKITT’S lymphoma/leukemia
presents more often as a lymphoma
occurs in both children & adults

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16
Q

ALL L3 morphology

A 
Large lymphoblasts
nuclear shape is regular
nucleoli is prominent
cytoplasm is abundant & deeply basophilic
VACUOLIZATION
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17
Q

WHO classification of ALL

A
  1. precursor B & precursor T cell neoplasms

2. Burkitt type (L3)

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18
Q

Precursor B-Cell Leukemia

A

B-Cell ALL or B-ALL
80-85% of ALL cases in children
70% of cases in adults

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19
Q

B-ALL characteristics

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A

B lymphoblasts - TdT +, HLA-DR +, CD19+
B-ALL w/ CD10 + have best prognosis
cytogenetic abnormalities include : translocation, hypodiploidy, hyperdiploidy

20
Q

Translocation

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A

2 broken off chromosome pieces of chromosomes are exchanged

most common translocation in childhood B-ALL : t(12;21)

21
Q

Hypodiploidy

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A 
# of chromosomes per cell that is less than 2n
30-39
22
Q

Hyperdiploidy

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A

of chromosomes per cell is more than 2n

23
Q

B-ALL prognosis

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A

usually good
children complete remission rate is 95%
adults - 60-85%

24
Q

Precursor T-Cell Leukemia

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A

T-ALL
15% of children ALL/ 25% of adults
high WBC
Lymphoblasts are more variable in size & cytoplasmic vacuoles may be present

25
T-ALL clinical findings
Lymphoblasts are TdT+, CD7+ , CD3+ | cytogenetic - translocations
26
Acute Myeloid Leukemia General Characteristics
affects CFU-GEMM affects neutrophils, platelets, RBCs, monocytes common in infants & older adults rapidly fatal if not treated
27
AML PB lab findings
WBC - increased, normal, decreased anemia thrombocytopenia BLASTS- auer rods common
28
AML BM lab findings
hypercellular w/ decreased fat content | predominance of blasts - auer rods present
29
Acute Myeloblastic Leukemia (M0)
rare myeloblasts w/o granules myeloperoxidase & sudan black B - negative
30
Acute Myeloblastic Leukemia w/ Minimal Maturation (M1)
common (20%) myeloblasts w/ or w/o scant granules, auer rods can be present myeloperoxidase & sudan black b - POSITIVE
31
Acute Myeloblastic Leukemia w/ Maturation (M2)
most common (30%) myeloblasts w/ granules, promyelocytes & few myelocytes auer rods present myeloperoxidase & sudan black b - POSITIVE
32
Acute Promyelocytic Leukemia (M3)
15% of AML myeloblasts, promyelocytes w/ prominent granules auer rods common faggot cells- multiple Auer rods occurring in bundles
33
Acute Promyelocytic Leukemia (M3) Stain reactions
myeloperoxidase & sudan black b - POSITIVE specific esterase - positive nonspecific esterase - negative
34
Acute Myelomonocytic Leukemia (M4)
20% of AML myeloblasts & promyelocytes >30% marrow cells promonocytes & monoblasts >20% auer rods may be present
35
Acute Myelomonocytic Leukemia (M4) Stain reactions
myeloperoxidase & sudan black b - POSITIVE specific esterase - positive nonspecific esterase - positive
36
Acute Myelomonocytic Leukemia w/ Eosinophilia (M4eo)
same as M4 w/ >5% abnormal eosinophils
37
Acute Monoblastic Leukemia w/o Differentiation (M5a)
5-15% of cases large monoblasts w/ lacy nuclear chromatin & abundant cytoplasm Specific esterase - negative nonspecific esterase- positive
38
Acute Monoblastic Leukemia w/ Differentiation (M5b)
monoblasts, promonocytes, blood monocytosis specific esterase - negative nonspecific esterase - positive
39
Acute Erythroleukemia (M6)
rare erythroid blast (pronormoblasts) & precursors >50% PB: poikilocytosis & anisocytosis
40
Acute Erythroleukemia (M6) Stain reactions
myeloperoxidase & sudan black b - positive specific esterase - positive PAS - POSITIVE
41
Megakaryocytic Leukemia (M7)
rare megakaryoblasts, possible cytoplasmic budding myeloperoxidase & sudan black b negative
42
WHO AML classifications
1. AML w/ characteristic/ recurrent genetic abnormalities 2. AML w/ multilineage dysplasia 3. AML & MDS; therapy related 4. AML not otherwise categorized (all of FAB)
43
AML w/ characteristic genetic abnormalities
better prognosis translocations: t(8;21), t(15;17) inversions in chromosomes: inv(16) 11q23 abnormalities
44
AML w/ multilineage dysplasia
prior MDS or MPD that transforms into AML | most often in elderly patients & often worse prognosis
45
AML & MDS therapy related
prior chemo &/or radiation and subsequently develop AML or MDS often carry a worse prognosis
46
AML not otherwise categorized
includes all of FAB classification

Hematology (14 decks)

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