LEUKOCYTE DISORDERS PART 2 NEOPLASTIC AND RELATED DISORDERS Flashcards
(150 cards)
1
Q
NEOPLASTIC AND RELATED DISORDERS
A
- Leukemias and Leukemoid Reactions
- Myeloproliferative Disorders
- Lymphoproliferative Disorders
- Plasma Cell Dyscrasias and Lymphoreticular
Malignancies Associated with Abnormal
Immunoglobulin Synthesis
2
Q
are generalized neoplastic proliferation or
accumulation of leukopoietic cells with or without
involvement of the peripheral blood.
A
LEUKEMIAS
3
Q
LEUKEMIAS
are generalized _____ or
______ with or without
involvement of the peripheral blood.
A
neoplastic proliferation or
accumulation of leukopoietic cells
4
Q
LEUKEMIAS are group of malignant disorders affecting _____, ____
and _____.
A
blood and blood forming tissue of the bone marrow
lymph system and spleen.
5
Q
CLASSIFICATIONS OF LEUKEMIA
A
1 Chronologic (based on natural history)
2 Cytologic (based on predominant cell type)
3 Classification based on functional capacity of
release mechanism
4 Classification based on localized proliferation of cells of the same type
6
Q
Chronologic CLASSIFICATION OF LEUKEMIA is based on?
A
natural history
7
Q
Cytologic CLASSIFICATION OF LEUKEMIA is based on?
A
predominant cell type
8
Q
the cells of precursor B-cell acute lymphoblastic leukemia are all
A
immature cells
9
Q
CONDITIONS ASSOCIATED WITH CHRONOLOGIC (BASED ON NATURAL HISTORY)
A
- ACUTE LEUKEMIA
- CHRONIC LEUKEMIA
- SUB-ACUTE LEUKEMIA
10
Q
The most common form of leukemia in
children. Characterized by a rapid increase in the numbers of immature blood cells
—> rapidly progressing, lasting for several days
to six months
—> very fast
A
ACUTE LEUKEMIA
11
Q
Acute leukemia is characterized by?
A
a rapid increase in the numbers of immature blood cells
12
Q
Acute leukemia is rapidly progressing, lasting for about?
A
several days to six months
13
Q
—It is characterized by the excessive build up of
relatively mature, but still abnormal, white
blood cells
—mostly occurs in older people, but can
theoretically occur in any age group
—most patients will live a minimum of 1 or 2
years or more
A
CHRONIC LEUKEMIA
14
Q
CHRONIC LEUKEMIA is characterized by the
A
excessive build up of relatively mature, but still abnormal, white blood cells
15
Q
CHRONIC LEUKEMIA mostly occurs in
A
older people, but can theoretically occur in any age group
16
Q
IN CHRONIC LEUKEMIA most patients will live a minimum of
A
minimum of 1 or 2 years or more
17
Q
a type of chronologic leukemia that last from 2 to 6 months or even 12 months
A
SUB-ACUTE LEUKEMIA
18
Q
ONSET OF ACUTE LEUKEMIA
A
Abrupt
19
Q
ONSET OF CHRONIC LEUKEMIA
A
Insidious
20
Q
Death of px with ACUTE LEUKEMIA
A
w/in months
21
Q
Death of px with CHRONIC LEUKEMIA
A
w/in years
22
Q
White cell count of ACUTE LEUKEMIA
A
Elevated / Normal / Low (LEN)
23
Q
White cell count of CHRONIC
LEUKEMIA
A
Elevated
24
Q
Appearance of cells in ACUTE LEUKEMIA
A
Blasts (immature)
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Appearance of cells in CHRONIC LEUKEMIA
Mature
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Neutropenia in ACUTE LEUKEMIA, present or absent?
Present
27
Neutropenia in CHRONIC LEUKEMIA, present or absent?
Absent
28
Anemia in ACUTE LEUKEMIA, present or absent?
Present
29
Anemia in CHRONIC LEUKEMIA, present or absent?
Present
30
Platelets in ACUTE LEUKEMIA
LOW
31
Platelets in CHRONIC LEUKEMIA
Normal / increased
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Organomegaly in acute leukemia
(abnormal enlargement of organs)
Mild
33
Organomegaly in chronic leukemia
(abnormal enlargement of organs)
Severe
34
Sub classification of acute leukemia
Acute Non lymphocytic Leukemia (ANLL) and Acute lymphoblastic leukemia
(ALL)
35
Acute nonlymphocytic leukemia or ANLL is more commonly called _________.
acute myeloid leukemia (AML).
36
Sub classification of acute leukemia
Chronic Myeloid Leukemia (CML)
Chronic lymphocytic leukemia (CLL)
37
T/F: ANLL and ALL both have subtypes
TRUE
38
T/F: CML and CLL both have subtypes
FALSE
---> CLL has subtypes
39
LEUKEMIA BASED ON PREDOMINANT CELL TYPE (CYTOLOGIC)
1. GRANULOCYTIC OR MYELOCYTIC LEUKEMIA
2. LYMPHOCYTIC/LYMPHOID LEUKEMIA
3. MONOCYTIC LEUKEMIA
4. PLASMA CELL LEUKEMIA
5. MAST CELL LEUKEMIA
6. HISTIOCYTIC LEUKEMIA
7. MEGAKARYOCYTIC LEUKEMIA
8. BASOPHILIC LEUKEMIA
40
the predominant cells are all cells coming from
common myeloid progenitors
Granulocytic or Myelocytic Leukemia
41
Under Granulocytic or Myelocytic Leukemia, we have (MPACE)
a. Acute Myeloid/Myeloblastic Leukemia
b. Chronic Myeloid Leukemia
c. Promyelocytic Leukemia
d. Myelomonocytic Leukemia
e. Eosinophilic Leukemia
42
in Lymphocytic/Lymphoid Leukemia, the predominant cells are all cells coming from
common lymphoid progenitors
43
2 types of Lymphocytic/Lymphoid Leukemia
a. Acute Lymphocytic Leukemia
b. Chronic Lymphocytic
44
CLASSIFICATION BASED ON FUNCTIONAL
CAPACITY OF RELEASE MECHANISM
1. LEUKEMIC LEUKEMIA
2. SUBLEUKEMIC LEUKEMIA
3. ALEUKEMIC LEUKEMIA
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presence of immature or abnormal cells with
WBC count greater than 15 x 10^9 /L
LEUKEMIC LEUKEMIA
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LEUKEMIC LEUKEMIA WBC count value
> 15 x 10^9 /L
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with immature or abnormal cells in peripheral blood and with WBC count less
than 15 x 10^9/L
SUBLEUKEMIC LEUKEMIA
48
SUBLEUKEMIC LEUKEMIA WBC count is
less than 15 x 10^9/L
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with no immature cells in the peripheral
blood and with WBC count less than 15 x
10^9/L
ALEUKEMIC LEUKEMIA
50
CLASSIFICATION BASED ON LOCALIZED
PROLIFERATION OF CELLS OF THE SAME TYPE
1. CHLOROMA
2. MYELOBLASTOMA
3. MYELOMA
4. LYMPHOMA
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---a type of myeloblastic leukemia
--- formation of tumors originating from periosteum, especially of skull, orbits, nasal
sinuses, ribs and vertebrae
-- bone, lungs, lymph nodes
CHLOROMA
52
CHLOROMA is a type of myeloblastic leukemia
with formation of tumors originating from
periosteum, especially of skull, orbits, nasal
sinuses, ribs and vertebrae
bone, lungs, lymph nodes
53
a focal malignant tumor composed of
myeloblast or early myeloid precursors
occurring outside of the bone marrow
MYELOBLASTOMA
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local tumorous proliferation of plasma
cells in the marrow
MYELOMA
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~ proliferation of one of the cell types of
the lymphopoietic reticular tissue
~ it begins and involves lymph nodes
predominantly and sometimes other sites
such as the spleen and GIT
LYMPHOMA
56
LYMPHOMA
~ proliferation of one of the cell types of _____
lymphopoietic reticular tissue
57
LYMPHOMA it begins and involves_____ predominantly and sometimes other sites
such as ____ and _____.
lymph nodes
spleen and GIT
58
is a reactive but excessive leukocytosis
characterized by the presence of immature cells in the peripheral blood
LEUKEMOID REACTIONS
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LEUKEMOID REACTION, high WBC indicates
– infections
60
increase in the total of leukocyte count in which
mimics ______
leukemia
61
LEUKEMOID REACTION increases in
50x10^9/L or 60x10^9/L
62
causes of increase leukemoid reaction
CAUSES
1) Severe infections
2) Hemolytic anemias
3) Tuberculosis
4) Trichinella spiralis infestation
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group of neoplasms characterized by proliferation of myeloid tissue and elevation in one or more myeloid cell type in the peripheral blood
MYELOPROLIFERATIVE DISORDERS
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2 TYPES OF MYELOPROLIFERATIVE DISORDER
1. ACUTE MYELOPROLIFERATIVE DISORDERS
2. CHRONIC MYELOPROLIFERATIVE DISORDERS
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CONDITIONS ASSOCIATED WITH ACUTE MYELOPROLIFERATIVE DISORDERS
a. myeloblastic leukemia
b. promyelocytic leukemia
c. myelomonocytic leukemia
d. Di Guglielmo ’s syndrome
66
CONDITIONS ASSOCIATED WITH CHRONIC MYELOPROLIFERATIVE DISORDERS
a. polycythemia vera
b. myelofibrosis with myeloid metaplasia
c. thrombocythemia
d. chronic myelogenous leukemia
e. myelodysplastic syndromes
67
is a neoplastic clonal MPD that commonly
manifests with panmyelosis in the bone
marrow and increases in RBC, granulocytes,
and platelets in the peripheral blood
POLYCYTHEMIA VERA
68
POLYCYTHEMIA VERA manifests with ____
panmyelosis in the bone marrow
69
POLYCYTHEMIA VERA IS INCREASED IN
RBC
granulocytes
platelets in the peripheral blood
70
a rare disease that occurs more often in men
than women
POLYCYTHEMIA VERA
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Major criteria polycythemia: hemoglobin is
>18.5 g/dl – men, >16.5 – girls.
72
Presence of ___- associated with bone
marrow disorder cause bu production of too
many blood cells
JAK2/ (janus kinase 2)
73
JAK 2 is associated with bone
marrow disorder caused by the
production of too many blood
cells
True
74
Minor criteria of polycythemia
bone marrow biopsy
---- will show the growth of prominent erythroid and granulocytic, megakaryocytic.
75
Morphologic changes – hgb is inc or dec?
increase( Normocytic normochromic)
76
MORPHOLOGIC CHANGES:
› Hemoglobin is increased
› RBC volume is increased
› Normocytic normochromic - morphology
› Total WBC count is increased
› Granulocytes and platelets – increased
77
Granulocytes, platelets (increase or decrease?)
increase
78
Treatment for polycythemia
1. Therapeutic phlebotomy
2. Low dose of aspirin--- to prevent thrombosis
› If the patient is high risk, we can give
hydroxyurea
3. High risk – hydroxyurea
4. Older – Busulfan
79
Other names of Myelofibrosis
Myeloid Metaplasia
Chronic Idiopathic Myelofibrosis
Osteomyelofibrosis
80
MYELOFIBROSIS is classified as a MPD in which the
proliferation of an abnormal type of BM
stem cell results in _____, or the
replacement of the marrow with
collagenous connective tissue fibers
fibrosis
81
Myelofibrosis -- peripheral blood film would exhibit ____and _____
and there is also presence of _____
and some____ shape of rbc
mature granulocytes and normoblasts
dacryocytes and some bizzare shape of rbc
82
clinical presentation of myelofibrosis; disease occurs in____y/o and also asymptomatic.
patient (60 yrs old) and also asymptomatic
(fatigue, weakness, shortness of breath,
weight loss, palpitations, pain in the left upper
quadrat, discomfort)
83
Treatment for myelofibrosis
– androgen therapy
› Prednisone
› Danazol
› Splenomegaly – hydroxyurea
84
has been known as primary thrombocytosis or Idiopathic thrombocytosis and also called hemorrhagic thrombocythemia
Thrombocythemia
85
Thrombocythemia is Characterized by autonomous proliferation of the
__________. Thrombocytosis is present without a reactive cause.
megakaryocytic cell lines
86
platelet count in THROMBOCYTHEMIA
Platelet - >600x10^9/L or 1000x10^9/L
87
WHO CRITERIA: requires thrombocytosis with
platelet count of _____
450 x 109/L or greater.
88
CLINICAL PRESENTATION of THROMBOCYTHEMIA:
› Elevated platelet count
› Enlargement of the spleen
› Bleeding occurs most frequently because
platelets are nonfunctional (occurs most
frequently from mucous membrane in the
gastrointestinal tract and upper
respiratory)
89
DIAGNOSIS of thrombocythemia
› JAK2
› Must be differentiated from secondary or
reactive thrombocytosis and from other
MPNs (myeloproliferative neoplasm)
90
TREATMENT for thrombocythemia
› Busulfan in older patients
› Low dose aspirin to prevent thrombosis
› - Hydroxyurea therapy
91
is a MPD arising as a clonal process from a
pluripotential stem cell
Chronic Myelogenous Leukemia
92
Chronic Myelogenous Leukemia begins with a chronic clinical phase that progresses to an accelerated phase in ____years and often terminates as an acute leukemia
3 to 4 years
93
Chronic Myelogenous Leukemia: characteristic feature present in proliferating
hematopoietic cells is the _____.
Philadelphia chromosome
94
has overproduction of myeloid cellulite that
results in preponderance of immature cells in the neutrophilic line
Chronic Myelogenous Leukemia
95
Chronic Myelogenous Leukemia hdias stain that wilfferentiatees between the CML from a glutamoid reaction, that we call ____
lab score
96
Clinical features of Chronic Myelogenous Leukemia
1. Frequent infection
2. Anemia (with bleeding)
3. Enlargement of spleen
4. WBC around 50-500x10^9/L
5. PBS show basophilia, eosinophilia, and
thrombocytosis
6. Can mimic neutrophilic glucamoid
reaction
97
TREATMENT of Chronic Myelogenous Leukemia
1. Bone marrow stem cell
transplantation
2. busulfan
98
are group of clonal
disorder of neoplastic pluripotential stem cells
characterized by a decrease in one or more
types of peripheral blood cells due to abnormal
maturation in the bone marrow
Myelodysplastic syndrome
99
FAB CLASSIFICATION OF MYELODYSPLASTIC
SYNDROMES
1. Refractory Anemia ( RA)
2.Refractory Anemia with Ringed sideroblasts
(RARS)
3. Refractory Anemia with excess Blast ( RAEB)
4. Chronic Myelomonocytic leukemia ( CMML)
5. Refractory Anemia with excess Blast in
Transformation ( RAEB-t)
100
(RARS)
Refractory Anemia with Ringed sideroblasts
101
( RA)
Refractory Anemia
102
RAEB
Refractory Anemia with excess Blast
103
CMML
Chronic Myelomonocytic leukemia
104
RAEB-t
Refractory Anemia with excess Blast in
Transformation
105
FAB classification – means
French, American, British Classification of Myelodysplastic syndrome
106
Features of PB and BM in Myelodysplastic Syndromes (% Blast PB)
RA - ˂ 1%
RARS - ˂ 1%
RAEB - ˂ 5%
CMML - ˂ 5%
RAEB-t - > 5%
107
Features of PB and BM in Myelodysplastic Syndromes (% Blast BM)
RA - ˂ 5 %
RARS - ˂ 5-20%
RAEB - ˂ 5-20%
CMML - ˂ 5-20%
RAEB-t - > 20-30%
108
Features of PB and BM in Myelodysplastic Syndromes (Dyserythropoiesis)
RA - +++
RARS - ++
RAEB = + / -
CMML = + / -
RAEB-t = + / -
109
Dysgranulopoiesis
RA = -
RARS = -
RAEB = ++
CMML = ++
RAEB-t = + / -
110
Dysmegakaryopoiesis
RA = -
RARS = -
RAEB = +/-
CMML = +/-
RAEB-t = + / -
111
Siderocytes/ Sideroblast
RA = +
RARS = +
RAEB = +/-
CMML = -
RAEB-t = + / -
112
Ringed sideroblast
RA = +/-
RARS = >15%
RAEB = +/-
CMML = -
RAEB-t = + / -
113
Specimen used in of PB and BM in Myelodysplastic Syndrome is
1 peripheral blood and 1 bone
marrow aspiration
114
represent a group of neoplastic conditions
originating from cells of the lymphoreticular
system
LYMPHOPROLIFERATIVE DISORDERS
115
TYPES OF LYMPHOPROLIFERATIVE DISORDERS
1) Acute Lymphoid Leukemia
2) Chronic Lymphocytic Leukemia
3) Hairy Cell Leukemia
4) Mycosis Fungoides and Sezary’s syndrome
5) Malignant Lymphoma
116
2 types of Malignant Lymphoma
a. Hodgkin’s Disease / Hodgkins lymphoma
b. Non-Hodgkin’s Disease
117
HAIRY CELL LEUKEMIA
composed of small B-lymphocytes with abundant
cytoplasm and fine (hairy) cytoplasmic
projections
--- Affected – b- lymphocytes
---Stain – TRAP(titrate resistant acid phosphate)
118
also known as Alibert-Bazin syndrome
MYCOSIS FUNGOIDES
119
MYCOSIS FUNGOIDES is the most common form of ____
cutaneous T-cell lymphoma
120
----is a lymphoreticular neoplasm
primarily involving the skin
--- as the disorder evolves, neoplastic
cells infiltrate the lymph nodes and
other visceral organs
MYCOSIS FUNGOIDES
121
- Classical Hodgkin lymphoma
- a malignant disorder characterized
by painless, progressive enlargement
of lymphoid tissue
HODGKIN’S DISEASE
122
3 major stages of mycosis fungoides
1. Initial erythematous stage - red scaly weeping
skin changes that resemble eczema psoriasis.
2. Plaque Stage
3. Final Tumor stage
123
lab findings in mycosis fungoides
o Lab Findings - large lymphocyte with cerebriform or hyperconvulated cell
124
Refers to a large group of benign and malignant
lesions of the lymphoid system
LYMPHOPROLIFERATIVE DISORDERS
125
T/F: Lymphoma is limited to the lymph nodes or
lymphoid organ
TRUE
126
HODGKIN’S DISEASE Hallmark
is a large binucleated or multinucleated cell with each nucleus bearing a very large nucleolus (Reed-Sternberg Cell)
127
positive for Hodgkin’s Lymphoma; Owl’s eye
appearance or popcorn cells
Reed-strenberg cell
128
-----Nodular lymphocyte-predominant Hodgkin
lymphoma
-----Is a B cell neoplasm composed of relatively rare
neoplastic cells scattered within the nodules of
reactive lymphocytes
NON-HODGKIN’S DISEASE
129
PLASMA CELL DYSCRATIAS AND LYMPHORETICULAR MALIGNANCIES ASSTD WITH ABNORMAL IG SYNTHESIS
1) MULTIPLE MYELOMA
2) WALDENSTROM’S MACROGLOBULINEMIA
130
MULTIPLE MYELOMA Other names
Plasmatocytoma
Kohler’s disease
131
is a neoplasmic proliferation of
morphologically abnormal plasma cells
primarily occurring in the BM either in
nodules or diffusely.
MULTIPLE MYELOMA
132
___ is detected in serum and urine of px with multiple myeloma
Bence Jones Protein
133
MM, ESR
ESR elevated / Rouleaux formation
134
WALDENSTROM’S MACROGLOBULINEMIA
o is an uncommon condition which
behaves as a slowly progressive
lymphoma
o is proliferation of cells which produce a
monoclonal IgM paraprotein
o Dx: asymptomatic w/ low level of IgM ( 3
g/dl) organomegaly , hyperviscosity
syndrome , anemia
135
is an uncommon condition which
behaves as a slowly progressive
lymphoma
WALDENSTROM’S MACROGLOBULINEMIA
136
OTHER LEUKOCYTE DISORDERS
1) INFECTIOUS MONONUCLEOSIS
2) HISTIOCYTOSES/ STORAGE DISEASE
3) SYSTEMIC LUPUS ERYTHEMATOSUS
137
Other name of INFECTIOUS MONONUCLEOSIS
Glandular
Fever Pfeiffer’s Disease
Kissing Disease
138
INFECTIOUS MONONUCLEOSIS is characterized by
fever
sore throat
lymphadenopathy
atypical lymphocytes in the bood
139
T cells reacting against B lymphocytes infected
with________
Epstein-Barr (EB) virus
140
IM is associated with high titer of ___
heterophile Ab reacting with sheep red cells
141
represent a group of diseases with abnormal proliferation of mesenchymal cells that are closely related to phagocytic histiocytes and to fat cells
HISTIOCYTOSES/ STORAGE DISEASE
142
it is also due to inborn errors in metabolism
genetically transmitted
HISTIOCYTOSES/ STORAGE DISEASE
143
is a collagen disease which affects
women most commonly
SYSTEMIC LUPUS ERYTHEMATOSUS
144
SYSTEMIC LUPUS ERYTHEMATOSUS is characterized by
skin rash
arthralgia,
fever,
renal,
cardiac and vascular lesions
anemia
leukopenia and
thrombocytopenia
145
3 TYPES OF ANTIBODY associated in SLE
a. Anti-DNP
b. Anti-DNA
c. Anti-nuclear
146
If performing in the laboratory, we need
______ then illalagay sa test tube and will
be mixed para masira. Nasa neutrophil sila na
merong nakaengulf na another cells or PMN
glass beads
147
treatment for SLE
no treatment but basically more on
supportive treatment
148
a disorder secondary to an infection with
the human immunodefficiency virus
(HIV).
AIDS – ACQUIRED IMMUNODEFICIENCY SYNDROME
149
HIV- an RNA retrovirus that is cytotropic
for ____ and ____.
CD4 positive T cells and macrophages
150
treatment for HIV
No treatment yet, more on retroviral and
slowing/decreasing the disease development
