Polycythemia and Leukemia Flashcards
(65 cards)
1
Q
What is polycythemia
A
Increased red cell concentration (increased PCV)
2
Q
Relative polycythemia
A
- not an absolute increase
- not that the red cell mass has increased but that the water portion/ plasma has decreased for some reason
3
Q
types of relative polycythemia
A
- Hemoconcentration (dehydration and fluid shifts)
- Redistribution (excitement, exercise)
4
Q
Absolute polycythemia
A
There is an actual increase in red cell production
5
Q
types of absolute polycythemia
A
- increased erythropoietin
- appropriate (chronic hypoxia)
- inappropriate (renal cysts, tumors)
- primary (polycythemia vera)
- myeloproliferative disorders
6
Q
an increased PCV and TP are indicative of…
A
dehydration (relative polycythemia)
7
Q
Possible Dx for macrocytic polycythemia, normal TP, EPO and arterial O2 Normal
A
polycythemia vera
8
Q
DDx for decreased arterial oxygen and increased EPO
PCV usually isn’t sky high
A
Dx: Hypoxemia
Heart function vs Lung Function (Imaging to differentiate)
9
Q
Leukemia
A
neoplastic cells in blood or bone marrow (spleen should also be included-some forms of lymphoid leukemia and T cell leukemia cells are produced solely in the spleen)
10
Q
types of leukemia
A
- Lymphoproliferative Disorders
- Myeloid neoplasms (Myeloproliferative disorders)
11
Q
lymphoma
A
Starts in the tissue can ultimately get a leukemia
with lymphoma
12
Q
Ways leukemias are classified
A
- Lymphoid vs myeloid
- Immunophenotype
- Acute vs chronic
- Cell morphology (small, large, LGL, etc)
- By number of circulating cells (aleukemic, subleukemic, leukemic)
- Leukemias may arise in bone marrow or spleen, but Stage V lymphomas are leukemic and these may be difficult to distinguish if they present late in disease
13
Q
Immunophenotyping Leukemias
A
The kinds of antigens the cells have on their membrane, recognized by antibodies against those antigens. The kinds of cell markers are very important for prognosis
14
Q
Acute vs Chronic Leukemia refers to
A
patient survival time
- Acute- effects immature cells (bone marrow and peripheral blood- blasts, lymphoblasts/myeloblasts)
- Chronic- typical cells look mature
15
Q
Acute Leukemia types
A
- Acute Lymphoblastic Leukemia (almost always this when acute)
- Acute Myelogenous Leukemia
16
Q
Chronic Leukemia types
A
- Chronic lymphocytic leukemia
- B-cell
- T-cell
- Chronic myeloproliferative
17
Q
Chronic Myeloproliferative leukemia
A
Common in people rare in dogs and cats
Can be difficult to distinguish from inflammatory leukograms: neutrophils are maturing and they can be orderly, become suspicious when neutrophil count is greater than 100,000
18
Q
Identification of cell types to classify lymphoid vs myeloid
A
- Morphologic appearance
- Cytochemical staining properties
- Electron microscopic appearance
- Monoclonal antibody binding to antigens
19
Q
CD 3, 4, 5, 8
A
T cells leukemias
20
Q
CD 21, 79a
A
B cell leukemias
21
Q
Simple Classification: Lymphoproliferative
A
- Lymphoblastic leukemia
- Lymphocytic leukemia
- Plasma cell leukemia (multiple myeloma)
22
Q
Simple Classification: Myeloproliferative
A
- Undifferentiated leukemia
- Granulocytic leukemia
- Monocytic leukemia
- Myelomonocytic leukemia
- Erythroid leukemia (erythremic myelosis)
- Megakaryocytic leukemia
23
Q
PCR detects
A
- antigen receptor rearrangements
- used to identify a clonal, neoplastic population of cells
- referred to as “PARR”
24
Q
PCR/ PARR differentiates
A
non neoplastic lymphoproliferative disorders from those that are neoplastic
Ehrlichia*
25
Acute leukemia
- neoplastic cells immature
| - Survival time is usually very short: MST – 9 days for ALL and AML (range, 1-120 days)
26
Chronic leukemia
- "mature" well-differentiated cells predominate
| - patient survival time is usually long
27
Acute Lymphoblastic Leukemia (ALL)
- Need to differentiate from Stage V lymphoma
- “65% of dogs presenting with multicentric lymphoma are leukemic.”
- 50% of dogs with ALL have lymphadenopathy
28
how to determine if lymphoblastic leukemia on cytology
- Use neutrophil for size comparison ( should be around the same size)
- Larger size and presence of nucleoli tells us they are immature cells or lymphoblast
- Cytoplasm will break off and get cytoplasmic fragments (almost look like platelets) - lymphoglandular bodies- Help to distinguish in cytology
Lymphoid cells rupture easily
29
T/F in cases of leukemia, animals can present with anemia, neutropenia, and thrombocytopenia
True: more prevalent in animals with acute leukemias
30
clinical signs of acute leukemia
Due to lack of normal hematopoietic cells or to infiltration of organs.
- Pale mucous membranes
- Splenomegaly
- Hepatomegaly
- Lethargy
- Weight loss
31
CBC abnormalities – Acute leukemias
- Anemia
- Thrombocytopenia
- Leukocytosis
- Mean TNCC – 98,000/μl
- Immature cells in blood
32
Prognosis- ALL
Poor
- Clinical course is usually rapid, progressive, and poorly responsive to therapy.
- Cats are usually younger and Fe-LV positive.
33
Acute Myeloid Leukemia
must have 20% or greater blast cells in the bone marrow.
| But % of blasts in blood is variable
34
T/F Very poorly differentiated myelogenous or myelomonocytic leukemia cannot be differentiated, based on morphology, from lymphoid leukemia
True
35
What is undifferentiated leukemia
Almost all cells in bone marrow are immature cells that cannot be classified based on morphology or cytochemistry.
Has features of both erythroid and myeloid Leukemia
36
how do you classify undifferentiated leukemia
immunophenotyping
37
Myeloblastic leukemia (M1)
>90% Blasts in BM;
38
Myeloblastic leukemia with differentation (M2)
20% blasts but 10% differentiated granulocytes
Often many promyelocytes
39
T/F Immune mediated neutropenia can appear similar to granulocytic leukemia
True! When we do a bone marrow aspirate, everything later is being destroyed by antibodies directed against its own neutrophils so what you have left are blasts. Occasionally missed diagnosed as leukemias but get better on steroids
40
Myelomonocytic leukemia (M4)
Myeloblasts and monoblasts >20% in BM
Monocytes and granulocytes > 20%
41
Monocytic leukemia (M5)
M5a Promonocytes and monoblasts; >80% of non erythroid cells
M5b >20% to
42
Erythroleukemia (M6)
Erythroid > 50%, myeloblasts and monoblasts
43
Megakaryoblastic leukemia (M7)
>20% megakaryoblasts, also in blood
Increased megakaryocytes
May need immunocytochemistry to detect reactivity for factor VII-related antigen and platelet glycoprotein IIIa
Thrombocytopenia or thrombocytosis
44
Chronic lymphocytic leukemia
Lymphocytes are small and appear well differentiated.
More common in dogs.
Must be differentiated from other causes of lymphocytosis.
>35,000 lymphs, it is leukemia.
45
T/F: T-cell CLLs are more common in dogs and cats than B-cell CLLs
true
46
where do T-cells tend to proliferate
the spleen
47
DDx of CLL in cats
excitement lymphocytosis (usually not greater than 20,000)
Bartonella henselae ("cat scratch fever")
48
DDx of CLL in dogs
Chronic ehrlichiosis (often see large granular lymphocytes)
Excitement lymphocytosis rare
Rarely hypoadrenocorticism
49
Clinical signs of CLL
May be asymptomatic (diagnose during wellness exam)
lethargy, anorexia, pale mucous membranes, lymphadenopathy, splenomegaly, hepatomegaly possible
50
Laboratory Findings for CLL
Lymphocytosis ( slightly increased to > 300,000/μl)
Maybe anemia thrombocytopenia
Increased small lymphs in BM
Rarely monoclonal gammopathy
Cats are usually Fe-LV neg
51
T/F immunophenotyping is not helpful for prognosis
False
52
T/F Myelodysplastic syndromes have variable manifestations, usually with subtle morphologic abnormalities
True
53
Myelodysplastic syndromes-cytopenia
single or in combination, including non- regeneratve anemia, neutropenia, and/or thrombocytenia.
54
Myelodysplastic syndromes-marrow
hypocellular, of normal cellularity or hypercellular.
55
Myelodysplasia
Often pre-leukemic
Reported in dogs, cats, rarely horses
Usually FeLV induced in cats
56
Chronic myeloproliferative neoplasms
Rare
Difficult to distinguish from hyperplasia
57
Chronic granulocytic (myelogenous) leukemia
More common in dogs than in cats
marked neutrophilia, left shift, and often monocytosis.
Hypersegmented nuclei, giant metamyelocytes, bands
58
DDx Chronic granulocytic (myelogenous) leukemia
Differentiated from MDS by marked leukocytosis.
Inflammatory responses (“leukemoid reactions”)
Marrow exam may not be helpful as orderliness of maturation may appear disrupted with inflammation
59
Definitive diagnosis of Chronic granulocytic (myelogenous) leukemia
Eventually develop disorderly left shift and “blast crisis”
Usually much more anemic than patients with inflammatory disease
60
Eosinophilic leukemia
Rare, primarily in FeLV-negative cats
Eosinophilia, immature eosinoiphils in blood, eosinophil predominance in marrow, eosinophil infiltration of organs
61
Clinical signs of Eosinophilic leukemia
similar to other MPDs but also include thickened bowel loops, diarrhea, vomiting due to eosinophil infiltration of intestine.
62
T/F Hydroxyurea and prednisone may prolong survival of patients with eosinophilic leukemia
true
63
Chronic basophilic leukemia
Very rare
Basophilia, orderly left shift, maybe thrombocytosis, organ infiltration
Differentiate from mast cell leukemia
64
Essential thrombocythemia
Very very rare
Platelets > 1,000,000/μl. Giant forms.
Increased megakaryocytes in marrow
65
DDx Essential thrombocythemia
iron deficiency anemia, inflammation, antineoplastic drug therapy, corticosteroids, neoplasia, all of which can cause thrombocytosis.
