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49 Cards in this Set
- Front
- Back
What are the different clonal neoplastic disorders of the bone marrow?
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Myelodysplastic syndromes
Chronic myeloproliferative disorders Acute leukemia |
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What occurs in aplastic anemia?
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Lack of stem cells to keep the peripheral counts at the levels that they need to remain
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What is a common finding in both aplastic anemia and the myelodysplastic syndromes?
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Cytopenias
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What are the findings in aplastic anemia?
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Pancytopenia with bone marrow hypocellularity
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What are the serious complications of aplastic anemia?
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Infection (neutropenia)
Anemia Bleeding (thrombocytopenia) |
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What are the causes of aplastic anemia?
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50% idiopathic
50%: various different bone marrow toxins |
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How do you classify the different types of myelodysplastic syndromes?
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Number of blasts
Severity of anemia Severity of thrombocytopenia |
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What finding is this? What is it a signal of?
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Ring sideroblast
It's a sign of myelodysplastic anemia |
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What is the cell type on the left? What disorder is present on the right?
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Neutrophil on the left
On the right: myelodysplastic syndrome with dysplastic neutrophils |
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What kind of cell is this here? What disorder is present at right?
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Megakaryocyte
On right: myelodysplastic megakaryocyte |
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What's a difference between chronic myeloprolieferative and myeloblastic syndromes?
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CMPD: elevated peripheral counts
Myelodysplastic: decreased peripheral gcounts |
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What are some other items on the differential for CMPDs?
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Neutrophilia/leukemoid reaction
Secondary polychthemia Reactive thrombocytosis |
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What is the leukemoid reaction?
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Reaction to a huge infection; can look like CMPD
Differences (in leukemoid reaction) -You see toxic granulation and Dohle bodies in neutrophils -Normal cytogenitics |
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What is secondary polycythemia?
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People live at high elevations-->push reticulocytes out into the peripheral blood due to the chronic hypoxia
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What are Dohle bodies?
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RER inside the cytoplasm
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What types of cells are the chronic myeloproliferative disorders associated with? What is the course?
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Cells: more differentiated leukocytes
Course: indolent |
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What types of cells are the acute myeloid and acute lymphoid leukemias associated with? What's the course?
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Cells: increased proportion of very immature cells (blasts)
Course: rapidly fatal! |
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What are the chronic myeloproliferative disorders?
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Chronic myelogenous leukemia
Polycythemia vera Primary myelofibrosis Essential thrombocythemia |
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What types of cells are found in chronic myelogenous leukemia?
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Blood, bone marrow proliferation of differentiated myeloid cells with left shift
Few blasts! Basophilia in the blood and bone marrow; way more than you'd expect to see! |
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What type of chromosome is found in chronic myelogenous leukemia?
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The Philadelphia chromosme
Balanced translocation between 22 and 9 |
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What is the dominant cell type in CML? What's the originating cell line?
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Dominant: granulocytic elements
Originating: multipotent stem cell |
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What's the natural history of CML?
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1. Accelerated phase
2. Blast phase: increased proportion of the blasts--> gets worse faster. -Some look like myeloid; some look like lymphoid |
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What are the findings in polycythemia vera?
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Increase in hemoglobin and hematocrit
Hypercellular bone marrow Moderate leukocytosis/thrombocytosis Decreased erythropoietin levels: hormone loop is intact |
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What mutation is present in PCV?
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JAK2 mutation
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What are complications of polycythemia vera?
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Thrombotic, hemorrhagic complications
Distension of blood vessels Platelet dysfunction |
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What's the late phase of polycythemia vera?
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Primary myelofibrosis
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What are the findings in primary myelofibrosis?
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Bone marrow becomes fibrotic, hypocellular
Progressive increase in extramedullary hematopoiesis (spleen, liver); splenomegaly Variable counts |
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What doe s a blood smear of primary myelofibrosis look like?
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Leukoerythroblastic peripherral blood smear
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What mutation is present in primary myelofibrosis?
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JAK2
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What type of cells go HAM in primary myelofibrosis?
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Fibroblasts!
You have fibrosis happen to the bone as an endpoin. |
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What happens in primary myelofibrosis?
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You have marrow elements going to the other organs after they hit the bones.
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What is the characteristic finding in primary myeloid fibrosis?
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Teardrop erythrocytes!
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What is essential thrombocytopenia?
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Sustained platelet count > 450E9
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What are the cytogenetic findings in essential thrombocytopenia?
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No philadelphia chromosome
No marrow fibrosis JAK2 mutation in 50% of cases |
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What are the findings in a smear for essential thrombocytopenia?
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Abnormal megakaryocytes
Abnormal platelets! |
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What are the findings in the acute leukemias?
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Bone marrow is largely populated by blasts
Leukemic blasts lead to an elevated WBC Leukemic cells invade other tissues |
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What's the definition of an acute leukemia?
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20-30% blasts in the acute leukemia
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What is the definition of acute lymphoblastic leukemia?
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>20% lymphoblasts in the bone marrow and/or peripheral blood
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What are the different subtypes of ALL?
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B cell
T cell |
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What's a sign of a poor prognosis in ALL?
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Philadelphia chromosome t(9;22)
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What do you see in the marrow for people with ALL?
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Monotonous bone marrow biopsies and smears: all blasts!
Blasts: -Larger -Irregular -Chromatin in the nuclei that you can see well |
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What is the definition of acute myeloblastic leukemia?
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>20% myeloblasts in the marrow or peripheral blood
They've got cytoplasmic granules and Auer rods |
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Who gets acute myeloblastic leukemia?
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Adults > kids
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What is an Auer rod? Where is it found?
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It's found in acute myeloblastic leukemia
Crystallized myeloperoxidase |
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What the hallmark findings of FAB M3-acute myeloblstic leukemia?
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Distinctive cells with lots of Auer rods
Characteristic chromosomal translocation t(15;17) High risk of DIC |
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What's the treatment for acute myeloblastic leukemia?
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Retinoic acid!
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What stain do we use for granulocytic differentiation?
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Myeloperoxidase
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What stain do we use for monocytic differentiation?
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Nonspecific esterase
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How do we differentiate between AML and ALL?
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Flow cytometry
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