MALIGNANT LEUKOCYTE DISORDERS

Question 1

What acute leukemia cellular morphology is most often associated with Disseminated Intravascular Coagulation (DIC)?

Answer 1

Blast-like cells with butterfly, reniform nuclear shapes and abundant auer rod

Question 2

According to the WHO classification, what is the minimal percentage of blasts required in bone marrow to confirm a diagnosis of acute leukemia?

Answer 2

20%

Question 3

Which cell line will demonstrate a diffuse positive reaction for a non-specific esterase α-Naphthyl acetate stain?

Answer 3

Monocytic

Question 4

According to the FAB classification, which leukemia demonstrates end-stage maturation at the promyelocyte stage with Faggot Cells?

Answer 4

M3

Question 5

Which of the following bone marrow disorders is best characterized by a peripheral blood smear showing immature granulocytes, nucleated NRBCs, tear drop RBCs and large and giant platelets?

Answer 5

Myelofibrosis

Question 6

What unique chimeric gene is found in Chronic Myeloid Leukemia?

Answer 6

BCR-ABL1

Question 7

Which cytochemical stains are useful in differentiating AML from ALL?

Answer 7

SBB

Question 8

Which leukemia accounts for up to 75% of childhood leukemia?

Answer 8

Acute lymphocytic leukemia

Question 9

What is the greatest transformational risk associated with the Myelodysplastic Syndromes?

Answer 9

Acute Leukemia

Question 10

How much of the nucleus must iron granules circle in order to be considered a ringed sideroblast?

Answer 10

At least 1/3 of the nucleus

Question 11

Why is it important to perform Pearl’s Prussian blue stain on a bone marrow aspirate smear?

Answer 11

To differentiate Iron Deficiency from Sideroblastic anemia

Question 12

What special stain would be used to differentiate CML from a leukemoid reaction?

Answer 12

LAP

Question 13

What genetic mutation is associated with Polycythemia Vera?

Answer 13

JAK2 gene

Question 14

Which of the following will demonstrate a negative MPO staining reaction?

Answer 14

M0

Question 15

Why is a bone marrow biopsy of the utmost importance in the diagnosis of Hairy Cell Leukemia?

Answer 15

The aspirate is a dry tap

Question 16

What best describes the morphology of typical CLL lymphocytes?

Answer 16

Small round lymphocytes with a soccer ball pattern

Question 17

What is present in patients with Multiple Myeloma?

Answer 17

Hypercalcemia, increased plasma cells, increased Monoclonal Immunoglobulin

Question 18

What is a distinct morphological difference between Lymphoblasts and Myeloblasts?

Answer 18

Auer Rods

Question 19

What is the definition of M/E ratio?

Answer 19

Myeloid:Erythroid ratio

Question 20

In flow-cytometry, what does CD stand for?

Answer 20

Cluster of Differentiation

Question 21

What auxiliary tests are routinely collected during a bone marrow aspiration?

Answer 21

Cytogenetics, Immunology (Flow) & Molecular

Question 22

What does cytogenetics testing do?

Answer 22

Identifies the type of AML, and gives specific gene translocation.

Question 23

What does immunology (flow) testing do?

Answer 23

Identifies the type of blasts – Myeloid vs.Lymphoid, Type of lymphocytes (B-Cell, T-Cell, can differentiate CLL from NHL)

Question 24

What does molecular testing test for?

Answer 24

Bcr/Abl1(Philadelphia Chromosome)

Question 25

What is the significance of Auer rods and what cells are they found in?

Answer 25

Auer rods indicate an AML and are found in Myeloblasts and abnormal promyelocytes

Question 26

What is the name of a mature red cell that contains iron?

Answer 26

Siderocyte

Question 27

What is a nucleated red cell that contains iron called?

Answer 27

Sideroblast

Question 28

12. What genetic translocation is found in M3?

Answer 28

t(15;17)

Question 29

16. What is the genetic translocation found in CML?

Answer 29

t(9;22)

Question 30

Name 3 abnormal features of cells seen in Myelodysplastic syndrome.

Answer 30

- Hypogranulation - Hypolobation - Nuclear-cytoplasmic dissociation

Question 31

What is the principle of LAP stain?

Answer 31

- Substrate naphthol AS-B1 phosphate is hydrolyzed by the LAP enzyme found in secondary neutrophil granules at an alkaline PH which combines w red dye to produce a color precipitate proportional to the amount of enzyme present.

Question 32

What is the principle of PAS?

Answer 32

Periodic acid oxidizes glycogen, mucoproteins, and HMW carbohydrates to aldehydes which react with colorless Schiff reagent to stain bright pink. Intensity and pattern depend on the aldehyde groups present.

Question 33

What does PAS differentiate?

Answer 33

Differentiate certain Lymphoid and abnormal erythroid cells(as in AML M6)

Question 34

What are the results for Sudan Black B?

Answer 34

AML(+) vs ALL(-) AML M0 and pure monocytic AML may also be(-)

Question 35

What does SBB stain?

Answer 35

stains lipids, the intensity of the staining is dependent on the amount of lipids present and the maturity of the cell.

Question 36

What is the principle of the Tartrate Resistant Acid Phosphatase (TRAP) stain?

Answer 36

Acid phosphatase hydrolyzes the substrate naphthol AS-B1 phosphoric acid and couples with a dye to produce a red precipitate. Hairy cells produce an abundance of isoenzyme 5.

Question 37

What do esterases – SE (Specific) & NSE(Nonspecific) differentiate?

Answer 37

Used to differentiate myeloblast and neutrophils from monocytic.