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Flashcards in WBC disorders Deck (121):
1

Causes of painless lymphadenopathy

  • Chronic inflammation
  • Metastatic carcinoma
  • Lymphoma

2

Treatment for follicular lymphoma

Rituximab (anti-CD20 antibody)

*Reserved for symptomatic patients

3

Which of the myeloproliferative disorders is not associated with increased risk for hyperuricemia or gout?

Essential thrombocythemia

4

Polycythemia vera is associated with a ________ mutation.

JAK2 kinase

5

What is the blood smear characteristic of mycosis fungoides?

Lymphocytes with cerebriform nuclei (Sezary cells)

6

Why is there an increased risk for infection in multiple myeloma?

monoclonal antibody lacks antigenic diversity; infection is the most common cause of death in multiple myeloma

7

Which neoplasm is associated with reactive polycythemia?

Renal cell carcinoma

8

most common age of patients with AML

50-60

9

Which markers are positive in Hodgkin lymphoma? 

CD15 AND CD30

10

Which type of myeloproliferative disorder rarely progresses to marrow fibrosis or acute leukemia?

Essential thrombocythemia

*Platelets are just blebs of cytoplasm from megakaryocytes

11

What is the cause of marrow fibrosis in myelofibrosis?

Megakaryocytes produce excess platelet-derived growth factor (PDGF) cuasing marrow fibrosis

12

Causes of eosinophilia

  • Allergic reactions (type I hypersensitivity)
  • Parasitic infections
  • Hodgkins lymphoma

13

A negative monospot test suggests ______ as possible cause of mono. 

CMV

14

T-ALL is characterized by which markers?

CD2 to CD8

*The blasts do NOT express CD10

15

Adult T- cell leukemia is associated with HTLV-1 and is most commonly seen in which countries?

Japan and the Caribbean

16

  • Lacunar cells
  • Enlarging cervical or mediastinal lymph node

Nodular sclerosis (Hodgkin lymphoma)

17

BCl2 expression in follicles. Follicular hyperplasia or follicular lymphoma.

Follicular lymphoma

18

The neoplastic cells of multiple myelome active the ________ receptor.

RANK receptor on osteoclasts

19

How is definitive diagnosis of mon made?

By serologic testing for the EBV viral capsid antigen

20

Characteristics of blasts

Large

Immature

punched out nucleoli

21

What sites are infected by EBV?

Oropharynx

Liver

B cells

22

Overexpression of cyclin D1 promotes _____ transition in the cell cycle, facilitating neoplastic proliferation.

G1/S

23

Gastric MALToma may regress with treatment of __________.

H.Pylori

24

Positive test for tartate-resistant acid phosphatase

Hairy cell leukemia

25

Subtypes of hodgkin lymphoma

  • Nodular sclerosis
  • Lymphocyte-rich
  • Mixed cellularity
  • Lymphocyte-depleted

26

Cytogenetic malfomation in Burkitt's lymphoma

t(8,14), resulting in the translocation of c-myc on chromosome 8 to IgH on chromosome 14

27

Rouleaux formation of RBCs on blood smear

Multiple Myeloma

*Increased serum protein decreases charge betCween RBCs

28

All of the myeloproliferative disorders are associated with a JAK2 kinase mutation, except _________.

CML

29

Acute presentation of leukemia

Anemia (fatigue)

Thrombocytopenia (bleeding)

Neutropenia (infection)

30

In my cosis fungoides, aggregates of neoplastic cells in the epidermis are called _________.

Pautrier microabscesses

31

Clinical features of multiple myeloma

  • Increased risk of infection
  • Hypercalcemia
  • Lytic lesions
  • M Spike- Elevated serum protein
  • Rouleaux formation
  • Primary AL amyloidosis
  • Proteinuria

32

Types of Acute Leukemia

Acute lymphoblastic leukemia

Acute myelogenous leukemia

33

Complications of most myeloproliferative disorders

  • Increased risk for hyperuricemia and goat due to high turnover of cells
  • Progression to marrow fibrosis or transformation to acute leukemia

34

Acute leukemia is the neoplastic proliferation of _________.

Blasts

*Accumulation of >20% blasts in the bone marrow

35

Types of Chronic Leukemia

  • Chronic lymphocytic leukemia
  • Hairy cell leukemia
  • Adult cell leukemia/lymphoma
  • Mycosis Fungoides

*Chronic leukemia is the neoplastic proliferation of mature circulating lymphocytes; characterized by a high WBC count

36

Which type of hodgkin has the best prognosis of all types?

Lyphocyte rich

37

CD1a+ 

S-100

Langerhans cell histiocytosis

38

Causes of lymphopenia

  • Immunodeficiency
  • High cortisol stae
  • Autoimmune destruction
  • Whole body radiation

39

  • Bone pain with hypercalcemia
  • M spike
  • Anemia
  • Bone lytic lesions
  • Renal involvement

Multiple myelome

40

Where does T cell hyperplasia occur to cause splenomegaly in EBV infections?

T-cell hyperplasia in the periarterial lymphatic sheath (PALS), white pulp

41

What bacterial infection causes lymphocytic leukocytosis?

Bordetella pertussis

*Produce lymphocytosis-promoting factor, which blocks circulating lymphocytes from leaving the blood to enter the lymph node.

42

How do high cortisol states lead to neutrophilic leukocytosis?

Impairs leukocyte adhesion, leading to release of marginated pool of neutrophils

43

Clinical features of Adult T cell leukemia

  • Rash 
  • Generalized lymphadenopathy with hepatosplenomegaly
  • Lytic bone lesions with hypercalcemia

44

Treatment for Waldenstrom macroglobulinemia

Acute complications are treated with plasmapheresis, which removes IgM from the serum

45

Disruption of normal lymph node architecture. Follicular hyperplasia or follicular lymphoma.

Follicular lymphoma

46

Neoplastic proliferation of reed-sternberg cells 

Hodgkin lymphoma

47

  • blurry vission and headache
  • Budd-Chiari Syndrome
  • Flushed face
  • Itching

Polycythemia vera

48

What types of NHL lead to proliferation of intermediate-sized B cells?

Burkitt's lymphoma

49

How is polycythemia vera distinguised from reactive polycythemia?

  • In PV, erythropoietin levels are decreased and SaO2 is normal
  • In reactive polycythemia , SaO2 is low and EPO is increased
  • In reactive polycythemia due to ectopic EPO production from renal cell carcinoma, EPO is high and SaO2 is normal.

50

Chronic myeloid leukemia is driven by t(9,22) which generates a BCR-ABL fusion protein with increased ________ activity.

Tyrosine kinase

51

Tingible body macrophages. Follicular hyperplasia or follicular lymphoma.

Follicular hyperplasia

*Cells undergo apoptosis in follicular hyperplasia. They do not in Follicular lymphoma

52

What cytogenic traits determine the prognosis of ALL?

  • t (12,21)- good prognosis
  • t (9,22)- poor prognosis

53

Viral infection will lead to what type of lymph node hyperplasia?

Paracortex

54

ALL has positive staining for _________. AML has positive staining for _________.

TdT; myeloperoxidase (MPO)

*TdT is found when staining the nucleus. MPO is found when staining the cytoplasm

55

Types of Acute myeloid leukemia

  • Acute promyelocytic leukemia
  • Acute monocytic leukemia
  • Acute megakaryoblastic leukemia

56

What is the most definitive characteristics of lymphoblasts ?

TdT

*TdT absent in myeloid blasts and mature lymphoctes

57

What are common symptoms of hodgkin lymphoma? What do these symptoms present?

  • Fevers, chills, weight loss, and night sweats
  • may lead to fibrosis
  • Reed- Sternburg cells secrete cytokines

58

What is the CD8 T cell response to EBV?

  • Generalized lymphadenopathy
  • Splenomegaly 
  • High WBC count with atypical lumphocytes in the blood

59

Myelofibrosis blood smear

Leukoerythoblastic smear

  • Tear drop RBCs
  • Nucleated RBCs
  • Immature granulocytes

60

Cuases of lymphocytic leukocytosis

  • Viral infections
  • Bordetella pertussis

61

What types of NHL lead to proliferation of small B cells?

Follicular lymphoma

Mantle cell lymphoma

Marginal zone Lymphoma

Small lymphocytic lymphoma

62

Cytogenetic abnormalities seen in acute promelocytic leukemia

  • t(15,17), which involves translocation of the retinioic acid receptor (RAR) on chromosome 17 to chromosome 15
    • RAR disruption blocks maturatuon and promyelocytes accumulate

63

Which type of hodgkin is associated with abundant eosinophils?

mixed-cellularity

64

Causes of monocytosis

  • Chronic inflammatory states
    • Autoimmune or infectious
  • Malignancy

65

Neoplastic proliferation of mature CD4 T cells that infiltrate the skin, producing localized skin rash, plaques, and nodules

Mycosis fungoides

66

Possible causes of reactive polycythemia

  • Lung disease
  • High altitude
  • Ectopic EPO production from renal cell carcinoma

67

ALL presents in children with down syndrome ______ (before/after) age of five. AML presents in children with down syndrom ____ (before/after) age of five. 

After; before

68

Treatment for neutropenia

GM-CSF or G-CSF

*Boost granulocyte production

69

Cytogenic marker for follicular lymphoma

t(14,18)

*BCL2 on chromosome 18 translocates to the Ig heavy chain locus on chromosome 14

70

High serum _______ may be present in multiple myeloma.

IL-6

*Stimulates cell growth and immunoglobulin production

71

What is the primary cause of symptoms seen in polycythemia vera?

Hyperviscocity of blood

72

Monoclonality. Follicular hyperplasia or follicular lymphoma.

Follicular lymphoma

73

Presentation of myelodysplastic syndromes

  • Cytopenias
  • Hypercellular bone marrow
  • Abnormal maturation of cells
  • Increased blast (<20%)

*Cells don't get out into blood

74

Crystal aggregates of MPO may be seen as _______.

Auer rods

75

The african form of burkitt's lymphoma involves the __________. The sporadic form involves the _________.

Jaw; abdomen

76

Cytogenetic problem in mantle cell lymphoma

t(11,14) in which Cyclin D1 gene on chromosome 11 translocates with IgH on chromosome 14

77

Complication of follicular lymphoma

Progression to diffuse large B-cell lymphoma

78

Chronic lymphocytic leukemia is the neoplastic proliferation of _________ cells that express CD5 and CD20.

Naive B Cells

79

How is CML distinguised from a leukemoid reaction?

  1. Negative leukocyte alkaline phosphaase stain
  2. Increased basophils
  3. t(9,22)

80

  • Blasts infiltrate gums
    • Lack MPO

Acute monocytic leukemia

81

_________ is used for screening for mono.

Monospot test

*Detects IgM antibodies that cross-react with horse or shep red blood cells (heterophile antibodies)

82

list examples of chronic inflammatory states associated with marginal zone lymphoma

  • Hashimoto thyroiditis
  • Sjogren syndrome
  • H. pylori gastritis

83

Rheumatoid arthritis and early stages of HIV infection will lead to what type of lymph node hyperplasia?

Follicular

84

Complications of chronic lymphocytic leukemia

  • Hypogammaglobulinemia
  • Autoimmune hemolytic anemia
  • Transformation to diffuse large B-cell lymphoma (Richter transformation)

85

Immature neutrophilic cells are characterized by decreased ______.

CD16 (Fc receptors)

*Results in decreased opsonization

86

Most common primary malignancy of bone

Multiple myeloma

87

  • Co expression of CD5 and CD20
  • Increased lymphocytes
  • Smudge cells

Chromic lymphocytic leukemia

88

Causes of infectious mononucleosis

EBV

CMV *less common

89

  • t(15, 17)
  • Increased risk for DIC

Acute promyelocytic leukemia

90

Causes of neutrophilic leukocytosis

  • Bacterial infection or tissue necrosis
  • High cortisol state

*Induce release of marginated pool (both) and bone marrow neutrophils, including immature forms (infection/necrosis)

91

Neoplastic proliferation of mature myeloid cells, especially RBCs

Polycythemia vera

92

In chronic lymphocytic leukemia, involvement of lymph nodes leads to generalized lymphadenopathy and is called __________.

Small cell lymphoma

93

In hairy cell leukemia, where are hair cells trapped in the spleen?

Red pulp

94

Clinical features of Hairy Cell Leukemia

  • Splenomegaly 
  • "Dry tap" on bone marrow aspiration

*Lymphadenopathy is usually absent

95

Clinical feautures of Waldenstrom macroglobulinemia

  • Generalized lymphadenopathy
  • Increased serum protein with M spike (IgM)
  • Visual and neurologic deficits
  • Bleeding

96

B-ALL is characteristized by lymphoblasts that express what markers?

CD10, CD19, CD20

97

___________ is the earliest change to emerge after whole body radiation.

Lymphopenia

98

Complications of mono

  • Increased risk for splenic rupture
  • Rash if exposed to ampicillin
  • Recurrence (due to dormancy) and B cell lymphoma (in immunodeficiency)

99

First line of treatment for CML

Imatinib, which blocks tyrosine kinase activity

100

How does T-ALL present in teenagers?

As a mediastinal thymic mass called a lymphoblastic lymphoma 

101

Which type of hodgkin is the most aggressive?

Lymphocyte-depleted

*Usually seen in the elderly and HIV-positive people

102

Draining of tissues with cancer will lead to what type of lymph node hyperplasia?

Sinus histiocytes (medulla)

103

ALL has an excellent response to chemotherapy but requires prophalaxis to _______ and ____.

Scrotum; CSF

104

Treatment of polycythemia vera

Phlebotomy

Hydroxyurea (second line)

105

Clinical features of myelofibrosis

  • Splenomegaly due to extramedullary hematopoiesis
  • Leukoerythroblastic smear
  • Increased risk of infection, thrombosis, and bleeding

106

Hematopoiesis occurs via a stepwise maturation of _______ hematopoietic stem cells.

CD 34+

107

Causes of painful lymphadenopathy

Lymph nodes draining a region of acute infection

108

Adult T-cell leukemia is the neoplastic proliferation of ___________ .

Mature CD4 T cells

109

Causes of neutropenia

  • Drug toxicity 
    • Damage to stem cells results  in decreased production of WBCs, especially neutrophils
  • Severe infection

110

Essential thrombocythemia is assocated with ________ mutation.

JAK2 kinase

111

Why does a high cortisol state lead to lymphopenia?

Induces apoptosis of lymphocytes

112

In CML, _________ suggests progression to accelerated phase of disease.

Splenomegaly

*Transformation to acute leukemia usually follows shortly thereafter

113

Primary effusion lymphoma associated with which virus

HHV8

114

Which form of MALToma is resistant to antibiotics?

t(11,18)

115

Which lymphoma is associated with a BRAF mutation?

Hairy cell leukemia

116

Fried egg appearance in bone marrow

Hairy cell leukemia

117

High Ki67

Diffuse large b cell lymphoma

118

CD38

Plasma cells

119

Stains for amyloid

Congo red stain

Apple green birefringence

120

CD20+, CD30-, CD15-

Nodular lympocyte predominant hodgkin

121

Conditions associated with a thymoma

Epithelial neoplasm of thymus

Myastenia gravis

Pure red cell aplasia