Hematology Lymphoid Flashcards by Denisse Tiangco

Normal WBC count

5-10k

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Neutropenia can be due to (2)

Drug toxicity

Severe infection

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Neutropenia tx

GMCSF

GCSF

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Lymphopenia causes (4)

Immunodef (DiGeorge Syndrome failure of thymus form)
High cortisol (apoptosis in lympho)
Autoimmune destruction (SLE) 
Whole body radiation (lymphocyte)

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Most sensitive cell to radiation

Lymphocyte

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Neutrophilic leukocytosis causes (3)

Bacterial i
Tissue necrosis
High cortisol

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Inc in immature precursor neutrophils with dec FC receptors that recognize IgG

Left shift

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Marker for dec FC receptor

CD16

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Disrupts adhesion of neutrophils in marginated pool

cortisol

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Monocytosis causes (2)

Chronic inflammation

Maligancy

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Eosinophilia causes (3)

Allergic reactions
Parasitic infection
Hodgkin lymphoma

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Eosinophilia occurs in hodgkins due to

inc IL5

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Basophilia occurs in

CML

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Lymphocytic leukocytosis (2)

Viral

Bordetella pertussis

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B pertussis produces prevents entry of lymphocytes to LN

Lymphocytosis promoting factor

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EBV infection resulting in lymphocytic leukocytosis comprised of reactive CD8 cells

Infectious mononucleosis

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EBV transmitted through

saliva

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EBV primarily affects

Oropharynx
Liver
B cells

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Generalized LAD
Splenomegaly periarterual lymph sheath
High white count of atypical lymphocytes by CD8 cell response

Infectious mononucleosis

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EBV infection results in hyperplasia of

paracortex LAD

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Which area of white pulp in spleen is affected by EBV

periarterial lymphatic sheath blue in histology

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Atypical lymphocytes (2)

Have larger nucleus
Abundant blue cytoplasm
Looks like monocyte

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Screening for IM

Monospot test

Detects IgM heterophile (affinity to bind RBC fr other animal) antibodies
Turns positive in 1 week after infection
Negative suggets CMV or early

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Definitive diagnostic for IM

EBV viral capsid antigen

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IM complications (3)

Inc risk for splenic rupture Rash if PCN Dormancy of virus in B cell

EBV inc risk for

Lymphoma in AIDS

Neoplastic proliferation of mature lymphocytes

Chronic leukemia

High WBC count | Insidious onset in older adults

Chronic leukemia

Neoplastic proliferation of B Cells

Chronic lymphocytic leukemia

B cells express (2) in CLL

CD5 and CD20

Inc lymphocytes and SMUDGE cells on blood smear

CLL

Splattered cell in CLL

Smudge cell

Generalized LAD | with small lymphocytic lymphoma (mass)

CLL

CLL Complications (3)

Hypogammaglobulinemia (loss of antibody production) Autoimmune hemolytic Transformation to diffuse large B cell lymphoma

MCC of death in CLL

Infection

Neoplastic proliferation of mature B cells Hairy cytoplasmic processes + TRAP

Hairy Cell Leukemia

HCL staining

Tartrate resistant acid phosphatase

Splenomegaly red pulp TRAPED in Dry tap with bm aspiration LAD ABSENT

Hairy Cell Leukemia

HCL responds excellently to

2 CDA

``` Adenosine deaminase (purine degradation pathway) inhibitor Adenosine accumulates to toxic levels in neoplastic B cells ```

2 CDA

Neoplastic proliferation of mature CD4 T cell

Acute T Cell Leukemia Lymphoma

ATLL associated with

HTLV1 in Japan and carribean (Human T cell leukemia virus 1)

Rash Generalized LAD with HSM Lytic bone lesions with hypercalcemia

ATLL

Neoplastic proliferation of mature CD4 T Cell

Mycosis fungoides

Aggregation of T crll in epidermis is called

Pautrier microabscess

CD4+ T cells like to go to forming

skin rash, plaque, nodule

Neoplastic CD4 T cells that spread to blood | Characteristic lymphocyte with cerebriform nuclei

Sezary syndrome

Pathognomonic of Sezary syndrome

Lymphocyte with cerebriform nuclei

Accumulation of precursors of myeloid lineage

Acute myelogenous leukemia

Accumulation of immature lymphoid lineage

ALL

Accumulation of mature lymphoid cells

Accumulation of mature myeloid cells

Myeloproliferative disorders

Overproduction of rbcs

Polycythemia vera

Disease of late adulthood High WBC count Hypercellular marrow Cells of all lineages inc

Myeloproliferative disorder

Myeloproliferative disorder complications (3)

1 hyperuricemia gout 2 marrow fibrosis 3 acute leukemia

Neoplastic proliferation of mature myeloid cells esp basophils

Chronic Myeloid Leukemia

CML translocation

t 9;22 BCRL ABL fusion with inc tyrosine kinase activity leading to overgrowth

Tx for CML

Imatinib | blocks tk activity

Phases of CML (3)

Chronic phase enlarged spleen suggesting acceleration worsening Acceleration phase Transformation phase - Acute Leukemia either AML or ALL bec mutation is in HSC

PCV tx (2)

Phlebotomy | Hydroxyurea

Tumor that produces EPO ectopically

Renal cell carcinoma

Proliferation of mature myeloid esp platelets | Associated with JAK2 kinase mutation

Essential thrombocythemia

IDA can also have inc

Platelet Differentiate from essential thrombocythemia

Inc risk of bleeding/thrombosis Rarely progresses to marrow fibrosis or acute leukemia No significant risk for hyperuricemia or gout

Essential thrombocythemia

Neoplastic proliferation of mature myeloid cells megakaryocytes Jak2 mutation

Myelofibrosis

Marrow fibrosis occurs in myelofibrosis because of

PDGF

Splenomegaly Leukoerythroblastic smear (reticulin gates prohibit immature cells from exiting to blood, does not occur in spleen) Inc infection, thrombosis bleeding

Myelofibrosis

Pathognomonic of myelofibrosis

tear drop cell

Painful LAD

acute

painless LAD

chronic, metastatic, lymphoma

Rheumatoid arthritis and HIV

follicle enlargement

Viral infection

Paracortex englargement

LN draining tissue with cancer

Sinus histoocytes

Neoplastic prolif of lymphoid cells that form a mass | Arise in LN and extra nodal tissue

Lymhpoma

60% of lymphomas

NHL

40% of Lymphoma

Small neoplastic B cells (4)

Follicular Mantle Marginal Small lymphocytic lymphoma

Neoplastic proliferation of small B cells CD20 making follicle like nodules Presents in late adulthood painless LAD

Follicular lymphoma

Follicular lymphoma is driven by

t 14;18 BCL2 on ch18 translocates to Ig heavy chain locus on ch14 Overexpression of bcl2 inhibiting apoptosis

Tx for Follicular lymphoma

Rituximab antiCD20 | Chemotherapy

Follicular lymphoma complication (2)

Progress to diffuse large B cell lymphoma | Enlarging lymph node

Follicular lymphoma is differentiated from hyperplasia by (4)

1 disruption of LN architecture 2 lack of tingible body macrophage in germinal center 3 monoclonality (ratio of kappa to lambda light chain disruptive 20:1

Neoplastic proliferation of small b cells that expand mantle zone Late adulthood painless LAD expands region adjacent to follicle

Mantle Cell Lymphoma

Mantle Cell Lymphoma is driven by

t 11;14 Cyclin D1 (helps cell go from G1 to S) phosphorylation on ch 11 translocates to Ig heavy chain ch 14

Neoplastic small B cells that expand marginal zone

Marginal zone lymphoma

Mantle B cell lymphoma is associated with (3)

Chronic inflamm states Hashimoto, Sjogren’s, H pylori Post germinal B cells form Marginal zone

Marginal zone lymphoma in mucosal site

MALToma

Neoplastic intermediate-sized B cells CD20 Associated with EBV

Burkitt lymphoma

Burkitt lymphoma (2)

African form jaw | Sporadic form abdomen!

Burkitt lymphoma is driven by

t 8;14 translocation of c-myc (nuclear regulator activating multiple genes resulting to a lot of growth) to Ig heavy chain locus on ch14

Burkitt has high mitotic rate pathognomonic of

Starry sky on histology

Neoplastic large B cells that grow diffusely in sheet

Diffuse large b cell lymphoma

Most common form of non hodgkin lymphoma | Aggressive

DLBCL

DLBCL arise (2)

sporadically | transformation of follicular lymphoma

Pathognomonic of Hodgkin

Reed sternberg cell

Neoplastic proliferation of reed sternberg cell which are large b cell with multilobed nuclei and prominent nucleoli CD15 CD30

Hodgkin lymphoma

Reed sternberg cell

Owl eye nucleus

RS cells secrete

Cytokine Hence with B symptoms Attract lympho mac plasma eo (mass formation) Fibrosis

Basis of subtype of Hodgkin

type of reactive cellularity

70% of cases of hodgkin

Nodular sclerosis

Hodgkin variants (4)

Nodular sclerosis Lymphocyte rich Mixed Lymphocyte depleted

Enlarging cervical neck or mediastinal LN in young adult female

Nodular sclerosis

Nodular sclerosis Hodgkin biopsy

Broad pink bands of fibrosis dividing lymph nides with RS cells in lake-like spaces lacunar cell

Hodgkin with best prognosis

Lymphocyte rich

Hodgkin with worst prognosis in elderly and HIV+

Lymphocyte-depleted

Abundant in the mixed cellularity type

eosinophil by il-5

Malignant proliferation of plasma cell in bm

Multiple myeloma

Most common primary malignancy of bone driven by

Multiple myeloma IL 6

Pathognomonic of MM

Punched out lesions on xray Bec of activation of RANK on osteoclast Bone pain with hypercalcemia

Elevated serum protein Immuneglobin Sharp spike M spike in gamma region of serum electrophoresis Indicating monoclonal immunoglobulin (IgG or IgA)

Multiple myeloma

Multiple myeloma inc risk of infection bec

(1) lack antigenic diversity Most common cause of death 2 dec charge in RBC - roleaux formation

Circulation and overproduction of free light chain in serum depositing in tissue

Primary AL amyloidosis

Free light chain excreted in urine

Bence Jones protein Deposition in kidney leads to risk of myeloma kidney

``` Inc serum protein M spike on SPEP No lytic lesion No hypercalcemia No amyloid No bence jones protein ```

Monoclonal Gammopathy of Undetermined Significance

MGUS is common in 1% develops

elderly Multiple myeloma

B cell lymphoma with monoclonal IgM production

Waldenstrom Macroglobulinemia

``` LAD no lytic bones Inc serum protein M spike IgM Visual and neuro deficits (inc viscosity) Bleeding ```

Waldenstrom Macroglobulinemia

WM complications tx

Plasmapharesis

Specialized dendritic cells in skin From bone marrow monocytes Present antigen to naive T cell

Langerhan cells

Neoplastic proliferation of LH crlls

Langerhan cell histiocytosis

LH pathognomonic for (2)

Birbeck tennis racket granules on em | CD1a+ S100+ IHC

Malignant proliferation of LH cell Skin rash and cystic skeletal defect in an infant Multiple organ Rapidly fatal

Letterer Siwe disease

Benign proliferation of LH cell in bone Pathologic fracture no skin involvement Langerhan cells with mixed inflamm and eosinophilia

Eosinophilia granuloma

Malignant proliferation of LH cell Scalp, rash, lytic skull, diabetes insipidus, exopthalmos child

Hand-Schuller-Christian

Hematology Lymphoid Flashcards

(124 cards)