Hematopathology I Flashcards
(86 cards)
1
Q
Pancytopenia
A
Major Causes
Aplastic anemia
Tumor in bone marrow
Marrow fibrosis
2
Q
Pancytopenia
A
Major Causes
3
Q
Pancytopenia
A
a
4
Q
Neutrophilia
A
a
5
Q
Neutropenia
A
a
6
Q
Agranulocytosis
A
a
7
Q
Leukemoid Reaction
A
a
8
Q
Leukoerythroblastic reaction
A
a
9
Q
Myelofibrosis
A
a
10
Q
Extramedullary hematopoeisis
A
a
11
Q
Chronic Myelogenous Leukemia
A
Relative Frequency
Age Distribution
Peripheral Blood findings
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
12
Q
AML
A
Relative Frequency
Age Distribution
Peripheral Blood findings
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
13
Q
Myelodysplastic syndrome
A
Relative Frequency
Age Distribution
Peripheral Blood findings
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
14
Q
Acute lymphoblastic Leukemia
A
Relative Frequency
Age Distribution
Peripheral Blood findings
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
15
Q
Chronic Lymphocytic leukemia
A
Relative Frequency
Age Distribution
Peripheral Blood findings
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
16
Q
Plasma Cell myeloma
A
Relative Frequency
Age Distribution
Peripheral Blood findings
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
17
Q
Neutrophilia
A
Major Causes
18
Q
Neutropenia
A
Major Causes
19
Q
Agranulocytosis
A
Major Causes
20
Q
Leukemoid Reaction
A
Major Causes
21
Q
Leukoerythroblastic reaction
A
Major Causes
22
Q
Myelofibrosis
A
Major Causes
23
Q
Extramedullary hematopoeisis
A
Major Causes
24
Q
Myelofibrosis
A
Major Causes
- Fibrosis of marrow
- Due to Chronic myeloproliferative disease
Metastatic tumors or lymphomas can also cause this
Radiation, chemicals, autoimmune also cause
25
Extramedullary hematopoeisis
```
Major Causes
=
- Hematopoietic cell production outside bone marrow
- Primarily Spleen or Lymph nodes/liver
Chronic myeloproliferative neoplasm
Severe hemolytic anemia
Marow replacement
```
Not observed in marrow aplasia
26
AML
Relative Frequency
Age Distribution
Peripheral Blood findings
- Accumulation of immature myeloid precursors
Bone marrow findings
-
Cytogenic abnormalities
Prognosis
Laboratory Features
27
Myelodysplastic syndrome
Relative Frequency
Age Distribution
Peripheral Blood findings
- Immature and defective hematopoiesis
Bone marrow findings
Cytogenic abnormalities
Prognosis
- Increased risk of becoming AML
Laboratory Features
28
Acute lymphoblastic Leukemia
Relative Frequency
Age Distribution
- Children
- Good prognosis
Peripheral Blood findings
- Acute lymphoid precursors
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
29
What does the evaluation of hematopoietic disorders begin with?
Peripheral blood smear
Percentage and number of erythrocytes and myeloid precursors
30
What are categories of white cell disorders?
Proliferative or Leukopenia
31
What is leukopenia?
Occurs as a result of increased consumption of white blood cells
Supression of myelopoeisis
Replacement of normal hematopoietic precursors
32
What is a monoclonal gammopathy?
Presence of immunoprotein from one clone
33
Neutrophilia
Major Causes
- Reduction in number of neutrophils
- Inadequate granulopoiesis (aplastic anemia)
- Ineffective granulopoiesis (B12 def, MDS)
- Accelerated removal (infection/immune mediated)
- Replacement of marrow
34
What is a sign of neutropenia?
Infected gums
35
Neutrophilia
Increase in PMNs
- Reactive (Demargination, Mobilization, Increased production)
- Neoplastic
36
Neutropenia
Major
- Reduction in number of neutrophils
- Inadequate granulopoiesis (aplastic anemia)
- Ineffective granulopoiesis (B12 def, MDS)
- Accelerated removal (infection/immune mediated)
- Replacement of marrow
37
Leukemoid Reaction
```
Extreme Leukocytosis
>50,000
-Resembles leukemia
Due to:
STRESS/INFECTION
```
38
AML
Malignant Clonal Expansion
Relative Frequency
Age Distribution
Peripheral Blood findings
- Accumulation of immature myeloid precursors
- BLAST with AUER ROD
Bone marrow findings
-
Cytogenic abnormalities
Prognosis
Laboratory Features
39
Acute lymphoblastic Leukemia
Relative Frequency
Age Distribution
- Children
- Good prognosis
Peripheral Blood findings
- Acute lymphoid precursors
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
40
What are some toxic changes?
Toxic granulation
41
What is a dohle body?
A pale blue structure in cytoplasm
42
What is seen in flow cytometry of AML?
CD13, CD33, CD117
43
What is an auer rod?
Needle accumulation of red granular material
- Myeloperoxidase
NEVER in LYMPHOID
44
AML
Malignant Clonal Expansion
Relative Frequency
Age Distribution
- ADULTS
- 20% of childhood leukemias
Peripheral Blood findings
- Accumulation of immature myeloid precursors
- BLAST with AUER ROD
Bone marrow findings
-
Cytogenic abnormalities
-t(15:17)
Prognosis
- 60-80% reach remission
- 25% 5 year survival
- 65% in
45
What do you use a myeloperoxidase stain for?
Positive for myeloid leukemias
NEVER LYMPHOBLASTS
46
What is the cytogenic abnormality of AML?
t(15:17) for better prognosis
- But acute promyelocytic leukemia
Use standard cytogenic techniques
47
What do you see in acute myelomonocytic leukemia?
Monocytic blast
- Large cell with abundant cytoplasm
- Azurophilic granulation
Promoncyte:
-Irregular/convoluted nuclear configuration
- More granulation
-Myeloid Blast: Smaller cells, round/oval nuclei
scant cytoplasm
48
What do you see in Promyelocytic leukemia?
Blasts: Kidney shaped
MIcrogranular variant
Hypergranular variant: Intense coarse azurophilic granules
Faggot cells (bundle of sticks)
ATRA: Induces differentation=
49
How do you treat AML with t(15:17)
This is promyelocytic leukemia
Treat with ATRA
50
Acute lymphoblastic Leukemia
Relative Frequency
Age Distribution
- Children MOST COMMON CANCER in children 1-7
- Good prognosis
Peripheral Blood findings
- Acute lymphoid precursors, lymphoblasts
- Anemia/thrombocytopenia
Bone marrow findings
Cytogenic abnormalities
Prognosis
Laboratory Features
51
What are the presenting features of ALL?
Fatigue, infections, bleeding
Bone pain
Organ Infiltration
CNS symptoms
52
What is the cure rate of ALL?
Most achieve remission (85% of children)
40% in adults
53
What is the cytochemical stain for ALL?
Myelo Negative
Flow cytometry is mostly B-cell
B cell: CD19, CD79a, CD22
Immaturity: TdT, CD34
54
Chronic Myelogenous Leukemia
Relative Frequency
Age Distribution
- Median Age: 55 years
Peripheral Blood findings
- Marked leukocytosis
- Eosinophilia IS COMMON
- Basophilia is INVARIABLY PRESENT
Bone marrow findings
Cytogenic abnormalities
t(9:22) Philadelphia chromosome (BCR-ABL)
Prognosis
- Imantinib is a better prognosis
Laboratory Features
55
Myelodysplastic syndrome
Relative Frequency
Characterized by cytopenias, ineffective hematopoiesis, dyspoiesis
Increased risk for AML transformation
Age Distribution
Peripheral Blood findings
- Immature and defective hematopoiesis
Bone marrow findings
Cytogenic abnormalities
Prognosis
- Increased risk of becoming AML
Laboratory Features
56
Chronic Lymphocytic leukemia
Relative Frequency
Age Distribution
>60yo
M>F
Generalized lymphadenopathy 50-60%
Peripheral Blood findings
- B-cell neoplasm
- Monotypic kappa or lambda light chains
Bone marrow findings
Cytogenic abnormalities
- Aberrantly expressed CD5
Prognosis
Laboratory Features
57
What are T cell lineage markers?
CD3, CD5, CD2, CD7, CD4, CD8
58
What are cytogenic abnormalities of Favorable B-ALL?
High Hyperdiploid (>50)
T(12:21) TEL-AML
59
What are unfavorable cytogenic abnormalities B-ALL?
Hypodiploid
t(9:22) BCR-ABL
11q23
60
What are diagnostic cells seen in CLL?
SMUDGE CELLS
| - Degenerating material of dying lymphocytes
61
What are the bone marrow findings in CLL?
Nodular
Interstitial
Diffuse
Small round lymphocytes
62
What is dysopoeisis?
Abnormal morphologic features of myeloid, erythroid, megakaryocytic
63
What are features of myelodysplastic syndrome?
Elderly
Infection, fatigue, hemorrhage
50% asymptomatic
64
What does prognosis depend on for myelodysplatic syndrome?
Blast percentage
Cytogenic abnormalities
Degree of cytopenias
Age
65
How do you classify MDS?
Cytologic
- RInged sideroblasts (erythrocytes)
- Dyspoiesis in one, two, or three cell lines
- Cytogenic abnormalities
66
What is a classic feature of blood smear in MDS?
Dimorphic red cell population (normochromic, hypochromic)
67
What is a hypolobate PMN?
One or two lobes instead of 3 -5
68
What distinguishes dysmegakaryopoiesis?
Small hypolobate megakaryocytes with nuclei spaced far apart
69
What are the cytogenics of MDS?
Chromosomal Abnormalities
Trisomies/deletions are common
Specific translocation are UNCOMMON
70
What are the types of chronic myeloproliferative neoplasms?
Chronic myleogenous leukemia
Polycythemia vera
Essential thrombocytopenia
Primary myelofibrosis
71
What is the mutation seen in some myeloproliferative neoplasms?
JAK2 V617F mutations
Seen in pts with polycythemia vera and half of patients with essential thrombocythemia/primary myelofibrosis
72
How does V617F mutation function?
It makes JAK active to phosphorylate downstream signaling molecules in the absence of signal to do uncontrolled proliferation (STATS)
73
What are signs of essential thrombocythemia?
Chronic myeloproliferative disorder
Thrombosis to hemorrhage
Splenomegaly in 50% patients
Adult Disease 50-60 year olds
Rarely transforms to AML or Myelofibrosis
74
What do you seen in essential thrombocythemia?
ATYPICAL MEGAKARYOCYTES (staghorn cells)
HIGH SURVIVAL
75
What age is primary myelofibrosis hit?
MIddle age and elderly
Progressive development of splenomegaly
SURVIVAL 3 years
5-20% progress to acute leukemia
76
What is the blood morph of primary myelofibrosis?
Tear drop RBCs
Leukoerythroblastic reaction- Immature myeloid cells and nucelated RBCs
77
What are the stages of Primary myelofibrosis?
Cellular stage :hypercellular
Fibrotic stage: Hypocellular marrow, increased marrow fibrosis, intrasinusoidal hematopoiesis
78
What are the stages of Primary myelofibrosis?
Cellular stage :hypercellular
Fibrotic stage: Hypocellular marrow, increased marrow fibrosis, intrasinusoidal hematopoiesis
79
What is the monoclonal immunoglobulin called in plasma cell neoplasms?
M-protein, monoclonal protein
80
What are the plasma cell neoplasms?
Monoclonal gammopathy of Undertermined significance
Solitary myeloma
Plasma cell Myeloma (worst)
81
What are features of MGUS?
Over 70
Incidental
25% progress to disease over 20 years
82
What are characteristics of solitary myeloma?
Solitary bone lesion
Extraosseous: Lung/pharynx or nasal sinuses
Treated with local radiation
83
What are characteristics of plasmal cell myeloma?
Bone Marrow
Monoclonal IgG, IgA, light chain protein in urine
See normal plasma cells (clock face chromatin
Symptomatic: HyperCalcemia (renal insu, anemia, bony LYTIC lesion)
Asymptomatic: M-protein in serum, bone marrow involvement
NO END ORGAN DAMGE
84
What do you see in plasma cell myeloma?
Lytic lesions of bone
Rouleaux: Linear arrays of RBCS
85
What is the prognosis of plasma cell myeloma?
>8 year survival
| Prognosis: Cytogenic, performance, LDH, Age
86
What are the therapies for plasma cell myeoma?
Immune modulators and proteasome inhibitors and autologus stem cell transplant
