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162 Cards in this Set
- Front
- Back
Definition of Leukemia |
Neoplasm of hematopoietic tissue characterized by uncontrolled proliferation of neoplastic blood cells with replacement of normal bone marrow elements with neoplastic blood cells |
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Etiology of Leukemia |
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Age of acute leukemia |
All ages |
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Age of chronic leukemia |
Adults |
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Clinical onset in acute leukemia |
sudden |
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Clinical onset in chronic leukemia |
insidious |
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Course if untreated in acute leukemia |
< 6 months |
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Course if untreated in chronic leukemia |
2-6 months |
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Leukemic cells acute leukemia |
immature |
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Leukemic cells chronic leukemia |
mature |
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Anemia acute leukemia |
mild to severe |
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Anemia chronic leukemia |
mild |
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Thrombocytopenia acute leukemia |
mild to severe |
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Thrombocytopenia chronic leukemia |
mild |
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WBC acute leukemia |
Variable |
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WBC chronic leukemia |
increased |
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Organomegaly acute leukemia |
mild |
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Organomegaly chronic leukemia |
prominent |
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Laboratory indentification |
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Bone Marrow Aspirate Smear |
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Bone Marrow Core biopsy |
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Peripheral count |
200 nucleated cells |
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Bone marrow count |
500 nucleated cells |
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t(8;21) |
AML-M2, favorable prognosis |
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inv(16) |
AML-M4, long remission |
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t(15;17) |
AML-M3, long survival |
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t(9;22) |
CML, ALL |
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t(8;14) |
Burkitt leukemia |
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t(4;11) |
ALL poor prognosis |
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-5/-7- |
AML/MDS poor prognosis |
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t(1;19) |
ALL (precursor B-cell type) |
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inv(14) |
T- cell lineage leukemia |
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Chronic Myeloid Neoplasms: Common Clinical features |
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BCR-ABL1 positive: |
Chronic Myelogenous Leukemia (CML) |
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Define CML |
a myeloproliferative neoplasm of pluripotent bone marrow stem cell |
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Most common |
MPN (15-20%) of all cases of MPN |
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CML is defined by the presence of the |
Philadelphia (Ph) chromosome and/or the BCR-ABL1 fusion gene |
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Philadelphia chromosome is a translocation between |
Chr 9 and 22 |
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ABL proto-oncogene is translocated from |
Chr 9 to Chr 22 |
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Part of BCR (M-BCR) gene is moved from |
Chr 22 to Chr 9
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Chimeric gene |
(BCR/ABL1): produces a phosphoprotein (p190 and p210) with high tyrosine kinase activity |
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M-BCR |
Exons: 12-16 Fusion proteins: p210 (CML) |
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m-BCR |
Exons: 1-2 p190 (ALL) |
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u-BCR |
Exons: 17-20 p230 (CML) |
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Clinical Features of CML |
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Peripheral blood smear of CML |
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LAP smear in CML |
low |
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Blasts in CML BM |
<5% |
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CML chronic phase |
Stable phase with leukocytosis, blasts <5% |
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Accelerated Phase CML |
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Blast Phase of CML |
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CML:Survival |
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Differential Diagnosis of CML |
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LAP stain |
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CML bone marrow biopsy characteristically show |
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Chronic leukemia |
Lymphoproliferative disorders Leukemia that are not acute lymphoblastic leukemias:
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Most common leukemia of adults in Western countries |
CLL (30% of all cases) |
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CLL is a neoplasm of |
mature B-cell involving peripheral blood, bone marrow, spleen and lymph nodes |
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If it is primary in the lymph nodes, it is |
Small lymphocytic lymphoma (SLL) |
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CLL/SLL is a neoplasm composed of |
monomorphic small, round to slightly irregular B lymphocytes in the peripheral blood, bone marrow, spleen, and lympho nodes
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In the absence of extramedullary tissue involvement, there must be |
>5X10^9/L monoclonal lymphocytes with a CLL phenotype in the peripheral blood |
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Clinical Features of CLL/SLL |
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Laboratory Findings CLL |
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Immunophenotype of CLL |
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Smudge cell is associated with |
CLL |
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SLL |
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Clinical Course of SLL |
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CLL is usually present in |
older adults |
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Asymptomatic or associated with infection, autoimmune hemolytic anemia, cytopenias due to heavy marrow involvement
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CLL |
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Hairy cell leukemia is a |
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HCL BM biopsy |
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Cytochemistry HCL |
Tartrate-resistant acid phosphate (TRAP) positive- most characteristic cytochemical feature |
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Hairy Cell Leukemia Immunophenotype |
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Clinical Features of Acute Leukemia |
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Diagnostic Techniques for Differentiating Leukemias |
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Acute Myeloid Leukemia is a disease of primarily |
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Other names for AML |
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Laboratory Evaluation of Acute leukemia |
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Bone Marrow of Acute Leukemia |
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Auer rods are see in |
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Blasts |
Myeloblast with immature cytoplasm with or without granules, some with Auer rods, loose open chromatin, some with distinct nucleoli |
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M0 |
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M1 |
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M2 |
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M3 |
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M3 or APL |
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M3m (APL) |
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BM in M3m |
Diffusely infiltrated by promyelocytes |
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M4 (AMML) |
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M4Eo |
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M5a (A Mono L) |
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M5b |
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M5 |
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M6 |
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Nucleated erythroid cells constitute > or = 50% of all nucleated bone marrow cells in a bone marrow specimen |
M6 |
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M6 PAS |
Positive |
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M7 |
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MPO |
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Sudan Black (SBB) |
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Specific Esterase |
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Non-specific esterase |
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M2 with t(8, 21) |
classified under the WHO category of AML with recurrent genetic abnormalities |
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M3 with a t(15,17) |
classified under the WHO category of AML with recurrent genetic abnormalities |
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M6a |
mixture of erythroid and myeloid cells |
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M6b |
pure erythroid leukemia: >80% pronormoblasts also known as true erythroleukemia |
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Prognosis with t(8;21) chromosome abnormalities in M2 |
Good |
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Prognosis with t(15;17) chromosome abnormality in M3 |
Good |
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Inversion of 16 in M4eo |
better prognosis |
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Treatment myeloid |
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Complete remission |
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Relapse |
reappearance of blasts in the blood or more than 5% leukemic blasts in BM |
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General Characteristics ALL |
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ALL statistics |
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ALL clinical findings |
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ALL Laboratory Findings |
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L1 |
small, uniform lymphoblast |
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L2 |
large, pleomorphic lymphoblasts |
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L3 |
Burkitt's type (vacuolated and deeply basophilic cytoplasm in lymphoblasts) |
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ALL most common in children |
L1 |
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ALL most common in adults |
L2 |
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Which ALL has a poor prognosis |
Burkitt Lymphoma |
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B-ALL |
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Accounts for 2 to 5% of all ALL |
Burkitt Lymphoma |
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Chromosome abnormalities |
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Most common form of ALL (70% of cases) |
B-ALL |
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B-ALL exhibit in children and adults |
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Where is B-ALL localized |
blood/bone marrow |
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Presentation of T-cell ALL |
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Males predominate |
T-Cell ALL |
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B-ALL immunophenotyping classification |
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T-ALL, T lymphocytes Immunophenotyping Classification |
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most specific marker of T ALL |
CD3 |
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All the Acute lymphoblastic leukemia are positive for |
TdT |
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Precursor B-cell Phenotype |
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Pre B-ALL phenotype |
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B-ALL phenotype |
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T-ALL phenotype |
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90% of ALL stains positive |
PAS |
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PAS negative |
L3 |
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TdT stain is useful is differentiating |
ALL from AML |
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ALL has a better prognosis in |
Children |
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Which ALL has the poorest prognosis |
L3 |
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Treatment for ALL |
Chemotherapy and Bone Marrow transplant |
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MPO |
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Sudan Black B |
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Specific Esterase |
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Nonspecific esterase |
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Add sodium fluoride inhibits the positive reaction in |
monocytes, confirms AMonoL |
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PAS |
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Acid Phosphatase stain |
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TRAP stain |
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LAP stain |
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LAP helps distinguish |
CML from leukemoid rxn |
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MPO helps distinguish |
AML or AMML from ALL |
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SBB helps distinguish |
AML or AMML from ALL |
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NCAE (specific) helps distinguish |
AML or AMML from ALL |
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NSE helps distinguish |
Monoblasts vs. myeloblast |
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TdT is useful in distinguishing |
ALL from AML |
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Cytoplasmic Ig |
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sIg |
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Myeloid cell markers |
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Lymphoid Markers for B cells |
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