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Flashcards in Heme Deck 1 Deck (40):
2

Vitamin B12 is essential for the synthesis of...

tetrahydrofolate, the biologically active form of folic acid

3

Folate is required for the synthesis of...

deoxythymidylate monophosphate, which is required for DNA synthesis

4

What kind of thrombophilia is associated with arterial thrombosis

HHC- hyperhomocysteinemia (elevated levels of homocysteine in the blood)

5

How is hyperhomocysteinemia acquired?

From vitamin B12/folate deficiency or inherited MTHFR deficiency

6

MTHFR

methylene tetrahydrofolate reductase; deficiency associated with hyperhomocysteinemia and thrombophilia

7

Myeloid blast phase in CML would contain which markers

CD13, CD33, or myeloperoxidase

8

Which blast phase of CML responds better to tx?

Lymphoid blast phase responds better to therapy than myeloid blast phase

9

The characteristic of marrow fibrosis and failure is seen in which 2 disease types?

Primary myelofibrosis and spent phase of polycythemia vera

10

Characterisitics typical of Primary myelofibrosis

Leukoerythroblastosis, DACROCYTES (teardrop cells), hypercellularity, marrow fibrosis and failure, enlarged spleen

11

What resembles reactive thrombocytosis

essential thrombocytosis

12

What condition is often associated wtih acute promyelocytic leukemia

DIC- low platelet count and fibrinogen (being consumed leading to bleeding, high number of clots leading to elevated D-Dimer, PT, and PTT

13

How is acute promyelocytic leukemia inherited?

t(15;17) translocation- rearrangement of retinoic acid receptor alpha gene on chromosome 17 with the PML gene on chromosome 15

14

Retinoic acid

important for granulocytic maturation

15

Tx for acute promyelocytic leukemia

chemo, ATRA- all trans retinoic acid allows granulocytic neoplastic cells to mature, and helps with DIC in acute promyelocytic leukemia

16

Myeloperoxidase

Enzyme present in primary granules of granulocyte precursors

17

A positive myeloperoxidase stain diagnostic of...

acute myelogenous leukemia

18

Blasts that express CD10, CD19, CD20, CD22, but not surface immunoglobulin diagnostic of

precursor B ALL

19

Blasts that express CD13, CD14, CD15, and CD33 diagnostic of

AML

20

AML classifications

AML caused by recurrent cytogenic abnormality, AML with multilineage dysplasia, therapy related AML (from chemo), and AML not otherwise categorized

21

2 man features in classifying AML not otherwise classified

Degree of differentiation of the neoplastic cells and the myeloid lineages represented

22

Different degrees of differentiation of AML

Minimally differentiated, AML without maturation, and AML with maturation

23

Which form of differentiated AML lacks myeloperoxidase expression

Minimally differentiated AML

24

Different types of AML based on myeloid lineages

acute promyelocytic leukemia, acute myelomonocytic leukemia, acute monocytic leukemia, acute erythroid leukemia, acute megakaryoblastic leukemia

25

Acute myelomonocytic leukemia

AML with both granulocytic and monocytic differentiation

26

What is t(15;17) translocation associated with

form of AML in which the cells cannot matures past the promyelocyte (promelanocyte) stage of differentiation into myelocyte stage

27

What is t(8;21) translation associated with

AML with maturation

28

inv(16)

acute myelomonocytic leukemia accompanied by numerous abnormal eosinophils

29

Abnormality at band 11q23

Acute monoblastic leukemia

30

What are myelodysplastic syndromes characterized by? (2 main features)

Ineffective hematopoiesis and morphologic dysplasia resulting from abnormal cellular maturation

31

Hypogranular cytoplasm, giant hypogranular platelets, abnormal lobulated erythroid precursors, and pseudo-pelger huet neutrophils along with hypercellular bone marrow

Myelodysplastic syndrome

32

Difference between myelodysplastic syndromes and myeloproliferatve disorders

Both produce hypercellular bone marrows, but MDS produces blood cytopenias (dec amounts of erythrocytes, platelets, and WBC's), while myeloproliferative disorders produce increased peripheral counts

33

What can MDS progress to

AML, so take these very seriously

34

Primary determinants of successful BMT

How close the HLA types are, how severe GVHD is, ability of the host to withstand the conditioning regimen

35

Basis of acute vs. chronic GVHD

reactivity of donor lymphocytes present in the bone marrow graft against host tissues- the greater the number of target antigens, the higher the incidence of GVHD

36

What is necessary for bone marrow engraftment?

Donor T cells

37

What is most important common infection in the first few months post BMT?

Cytomegalovirus infection

38

"owl-eye" appearance (intranuclear inclusion surrounded by clear halo), general interstitial thickening by mononuclear infiltrate, scattered cells with enlarged nuclei characteristic of

CMV-infection from BMT

39

Looking at slide, you see small cavities degenerating and necrosis of basal cells and acanthocytes, individual keratinocytes dying with lymphocytes, satellitosis, spongiosis, bullase. What disease process are these associated with

Acute Graft vs. host disease

40

How does acute Graft vs host disease affect GI tract

individual apoptotic epithelial cells in intestinal crypts- most severe changes found in distal ileum. Gland lumen with sloughed epithelial cells and debris, relative sparseness of the mononuclear cell infiltrate in colon

41

Where are the major affected cells in the liver in acute GVH disease located

within the portal triads