Section 21: A-(bunch of)-cutie Leukemias

Question 1

Male: RBC count, Hgb, & HCT Normal Ranges

Answer 1

RBC: 4.5 - 5.9 x 10^6 (△ 1.4)
Hgb: 13.5 - 17.5 x 10^3 (△ 4.0)
HCT: 41.0 - 53.0 (△12.0)

Question 2

Female: RBC count, Hgb, & HCT Normal Ranges

Answer 2

RBC: 4.0 - 5.2 x 10^6 (△1.2)
Hgb: 12.0 - 16.0 x 10^3 (△4.0)
HCT: 36.0 - 46.0 (△10.0)

Question 3

MCV, MCH, MCHC Normal Ranges

Answer 3

MCV: 80 - 96 (△20%)
MCH: 29 - 32 (△10%)
MCHC: 33.4 - 35.5 (△~5.0%)

Question 4

WBC Normal Range

Answer 4

4.0 - 11.0 x 10^3

Question 5

WBC Normal Range

Answer 5

4.0 - 11.0 x 10^3

Question 7

Plt Normal Range

Answer 7

140,000 - 400,000

Question 8

M0 Definition

Answer 8

Acute Myeloblastic Leukemia (AML) w/o cytological maturation or differentiation (cells committed but unable to tell which lineage)

Question 9

M1 Definition

Answer 9

Acute Myeloblastic Leukemia (APL) w/o maturation (but can be differentiated)

Question 10

M2 Definition

Answer 10

Acute Myeloblastic Leukemia (AML) w/ Maturation

Question 11

M3 Definition

Answer 11

Acute Promyelocytic Leukemia (APL)

Question 12

M3m Definition

Answer 12

Acute Promyelocytic Leukemia (APL) - Microgranular Variant

Question 13

M4 Definition

Answer 13

Acute Myelomonocytic Leukemia (AMML)

Question 14

M4e Definition

Answer 14

Acute Myelomonocytic Leukemia (AMML) w/ Eosinophilia

Question 15

M5a Definition

Answer 15

Acute Monoblastic Leukemia (AMoL), poorly differentiated

Question 16

M5b Definition

Answer 16

Acute Monocytic Leukemia (AMoL), differentiated

Question 17

M6 Definition

Answer 17

Acute Erythroid Leukemia

Question 18

M7 Definition

Answer 18

Acute Megakaryoblastic Leukemia

Question 19

L1 Definition

Answer 19

Acute Lymphocytic Leukemia - Small Lymphoblasts

Question 20

L2 Definition

Answer 20

Acute Lymphocytic Leukemia - Larger Blasts w Reactive Appearance

Question 21

L3 Definition

Answer 21

Leukemic Conversion of Burkitt’s Lymphoma

Question 22

Characteristics of M0

Answer 22

Requires Flow Cytometry or other Immunophenotyping
Non-responsive to cytochemical stains
Poor Prognosis
NO Auer Rods

Question 23

Characteristics of M1

Answer 23

MPO (+), SPE (+), NSE (+/=)
4000 - 300,000 WBC
Auer Rods possible
Decreased Plts

Question 24

Characteristics of M2

Answer 24

MPO (+), SPE (+), NSE (+/=)
Maturation of Promyelo- stage and beyond
Auer Rods possible
May be a late “acute phase” or “blast crisis” of CML

Question 25

Characteristics of M3

Answer 25

Acute Promyelocytic Leukemia (AML w/ t(15;17)) MPO (+), SPE (+), NSE (+/=) Frequent Auer rods, often multiple Extremely Heavy Granulation Decreased Plts DIC complication - schistocytes common hallmark & can be made worse w treatment Usually adults | BOTH M3 and M3m presentation simultaneously is possible, not exclusive.

Question 26

Characteristics of M3m

Answer 26

**Same as M3 except:** Granules so small they can't be seen normally Abnormal nuclear shapes (H, N, or Venn Diagram) May be mistaken for an AML or AMoL

Question 27

Characteristics of M4

Answer 27

Can demonstrate tissue infiltration of skin, gums, etc May have Auer Rods Blasts with both myelocytic and monocytic features Decreased Plts

Question 28

Characteristics of M4e

Answer 28

Same as M4 but with marrow eosinophilia (abnormal and immature forms, may also be in peripheral)

Question 29

Characteristics of M5a

Answer 29

Monoblastic w/ poor differentiation Decreased Plts Infiltration of the skin, gums, meninges and other body tissues by malignant cells

Question 30

Characteristics of M5b

Answer 30

**Same as M5a except** Monoctic lineage (blasts and abundance of promonos/monos)

Question 31

Characteristics of M6

Answer 31

Pure RBC precursors make up >80% marrow cellularity No myeloid component, NO Auer Rods Ringed Sideroblasts Many nrbcs, bizarre rbc morphology. immature rbcs extremely abnormal Marked erythroid hyperplasia Possible abnormal megakaryo and plts RBC indices afected by megaloblastic changes

Question 32

Characteristics of M7

Answer 32

Rarest AML NO Auer Rods 50% of blasts in BM must be megakaryoblasts Dysplastic features seen in all cell lines Associated with myelofibrosis due to megaryo stim effect on fibroblasts May cause dry tap

Question 33

General characteristics of ALLs

Answer 33

Disease of Children Most common form is B-Cells Can have 2nd peak mid life WBC often greater than 100,000 but low or normal also possible NO Auer Rods Decreased Plts and granulocytes CNS infiltration common

Question 34

Characteristics of L1

Answer 34

**Small lymphoblasts** Most common form Occ. clefting Inconspicuous nucleoli Scanty cytoplasm Uniform Population - homogenous TdT (+)

Question 35

Characteristics of L2

Answer 35

Large Lymphoblasts Irregular nucleus Often prominent nucleoli Often moderately abundant cytoplasm Cellular heterogeneity TdT (+)

Question 36

Characteristics of L3

Answer 36

Leukemic conversion of Burkitt's Lymphoma Large blasts w punched out vacuoles Very basophilic cytoplasm "Starry Night" BM TdT (=)