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Pathology II Exam 3 > 1 hematopathology 1: Myeloid and Lymphoid Bone Marrow Disorders (mike) > Flashcards

1 hematopathology 1: Myeloid and Lymphoid Bone Marrow Disorders (mike) Flashcards

1
Q

What is the normal myeloid to erythroid ration?

A

3:1

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2
Q

What is the approximate calculation of bone marrow cellularity?

A

100-age

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3
Q

Review the things a bone marrow biopsy offers that an aspirate might not…

A

Marrow cellularity
megakaryocytic numbers
aggregates of lymphocytes/blasts/tumor cells
fibrosis/or not

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4
Q

What is the order of granulocyte maturations from myeloblast to neutrophil?

A

myeloblast–> promyelocyte –> myelocyte –> metamyelocyte–> band –> neutrophil

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5
Q

What is the order of erythropoiesis from multi potential HSC to erythrocyte?

A

multipotential HSC–>common myeloid progenitor –> pro erythroblast–> basophilic erythroblast–> polychromatic erythroblast–> orthochromatic erythroblast–> polychromatic erythrocyte (reticulocyte)–>erythrocyte

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6
Q

Agranulocytosis has marked neutropenia to less than what level?

A
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7
Q

What is aplastic anemia? Is there an increase in reticulocytes?

A
  1. lack of hematopoietic cells in the bone marrow

2. No

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8
Q

What is granulocytic aplasia?

A

lack of granulocytic precursors in the marrow.

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9
Q

What is aplastic anemia? Is there an increase in reticulocytes? what does it look like?

A
  1. lack of hematopoietic cells in the bone marrow
  2. No
  3. just fat with little cellular type stuff
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10
Q

What is granulocytic aplasia? what does it look like?

A
  1. lack of granulocytic precursors in the marrow.

2. It looks like a bunch of schistocytes and target cells and few progenitors

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11
Q

In B12 deficiency there is defective DNA synthesis, but not defective RNA synthesis-what happens to the cells? what does it look like?

A
  1. cytoplasm matures, but nucleus remains immature (megaloblastic change)
  2. intramedullary death- pink jumbled mess of cells with a lot of cytoplasm and cells that look stuck in synthesis stages/metaphase stages
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12
Q

What is the clinical presentation of neutropenia

A

Infections- ulcerating necrosis of the mouth, necrotizing infections of the lung and UTI, massive colony bacteria growth

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13
Q

What are the 3 causes of reactive neutrophilia?

A
  1. demargination (from epinephrine release, acute stress, exercise, steroids)
  2. mobilization of maturation-storage compartment (steroids, infection, inflammation)
  3. Increased production (sustained infection, chronic)
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14
Q

What neoplasms (in general) lead to neutrophilia?

A

myeloproliferative neoplasms.

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15
Q

What neoplasms (in general) lead to neutrophilia? What does neutrphilia look like?

A
  1. myeloproliferative neoplasms.

2. increased absolute number of mature neutrophils in the CBC

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16
Q

What is a left shift?

A

immature granulocytic cells (band etc.) circulating in the blood. REMEMBER band cells over like 10% was SIRS

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17
Q

When are toxic changes in neutrophils seen?

A

acute infection and after administration of GCSF

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18
Q

In order for it to be toxic change in neutrophils in needs at least one thing from a criteria of 3. What is the criteria of three?

A
  1. toxic granulation (distinct course purple)
  2. cytoplasmic vacuolization
  3. Dohle bodies- pale blue structure (RER)
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19
Q

What is characterized by extreme leukocytosis, in response to stress or infection, may resemble leukemia, and has an increased immature cell population? what does it look like?

A
  1. leukemoid reaction

2. tons of neutrophils and band cells

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20
Q

What is a malignant neoplasm of hematopoietic cells characterized by diffuse replacement of the bone marrow by the neoplastic cells?

A

Leukemia

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21
Q

What is leukemia classified on the basis of? 3

A
  1. cell lineage (myeloid/lymphoid)
  2. Maturity (blasts vs. differentiated cells)
  3. chronicity (acute/chronic)
22
Q

What are the most common types of leukemia in adults?

A

AML and CLL

23
Q

What is the most common types of leukemia in children?

A

ALL

24
Q

What is a malignant clonal neoplasm of multi potent myeloid stem cells characterized by the accumulation of myeloblasts in the bone marrow and blood?

A

AML- block in differentiation of leukemic stem cells, and replacement/suppression of normal hematopoietic precursors.

25
Q

Review the sub-categories of AML?

A
  1. Based on specific cytogenetic abnormalities, dysplasia of the other cell lines, previous chemotherapy.
  2. may arise from any myeloid lineage cell
  3. monocytic, erythroid, megakaryocytic
26
Q

What three antigens in flow cytometry should we be thinking in AML?

A

CD 13, 33, 117

27
Q

In AML, what is a distinct histo characteristic we should be looking for?

A

Auer rods- only in myeloid blasts- red granular material containing MPO

28
Q

Is the MPO stain ever seen in lymphoid blasts?

A

NO!- postitive in a subset of myeloid leukemias only.

29
Q

T-F in acute promyelocytic leukemia blasts are often kidney shaped or bilobed?

A

True

30
Q

What are the granules like in Acute promyelocytic leukemia? 2 variants

A
  1. microgranular variant- fine/delicate

2. hypergranular variant- intense coarse azurophilic granules

31
Q

What is the translocation for acute promyelocytic leukemia with tons of ayer rods? What do we treat with?

A
  1. 15:17

2. all trans retinoic acid

32
Q

What is a large cell with abundant cytoplasm, fine azurophilic granulation; round nuclei with delicate chromatin and nucleoli?

A

Monocytic blast- monoblast

33
Q

What is a Irregular/convoluted nuclear configuration (looks like crumpled tissue paper); granulation more prominent than monoblast (may resemble that of monocytes)?

A

promonocyte

34
Q

What are smaller cells, round/oval nuclei, scant cytoplasm which is usually agranular

A

myeloblast

35
Q

When do we see monocytic blasts, promonocytes and myeloid blasts?

A

in acute myelomonocytic leukemia

36
Q

What do we see in acute megakaryoblastic leukemia on blood smear?

A
  1. cytoplamic blebs which break off to become hypo granular platelets (just a little larger than RBCs)
37
Q

What do we see in acute megakaryoblastic leukemia on blood smear?

A

1.megakaryoblasts- cytoplamic blebs which break off to become hypo granular platelets (just a little larger than RBCs)

38
Q

Is AML mainly a disease of children? what percentage of childhood leukemias does it represent? What are the main acute symptoms at onset? Does i often present with leukocytosis? pancytopenia?

A
  1. mainly adults
  2. 20% of childhood leukemias
  3. fatigue, infections, bleeding
  4. often leukocytosis
  5. occasionally pancytopenia
39
Q

In what AML subtype to we see DIC in?

A

acute promyelocytic leukemia

40
Q

In what AML subtype do we see infiltration of gums, skin, CNS more?

A

monocytic differentiation.

41
Q

What percentage of patients reach initial remission of AML? is relapse common? What is the 5 year survival for all AML? 5 year survival for children?

A
  1. 60-80%
  2. yes
  3. 25%
  4. 65%
42
Q

What is a neoplasm of lymphoid stem cells with accumulation of lymphoblasts with loss of normal hematopoietic cells? what does the peripheral blood smear show?

A
  1. ALL

2. may show markedly increased blasts or only rare blasts, anemia, thrombocytopenia

43
Q

t-f– ALL is the 2nd most common cancer in children 1-7?

A

Faslse- 1st

44
Q

What are the presenting features of ALL?

A

fatigue, infections, bleeding, bone pain, hepatosplenomegaly, CNS symptoms

45
Q

Is the prognosis good in ALL?

A

Yes- most achieve complete remission and approximately 85% of children are cured

46
Q

What determine lineage in ALL?

A

flow cytometic markers [most are precursor B cells and less are precursor T-cells)

47
Q

What are the 2 markers of immaturity in ALL?

A

TdT and CD34

48
Q

What are b-lineage markers in ALL?

A

CD19, 20, 79a, 22

10 is seen in B cell stuff too, but not as prominent in ALL as the above

49
Q

What are T-lineage markers in ALL?

A

CD3 !!!! and 2,4,5,7,8

50
Q

In B-ALL- is a high hyper diploid favorable or not? t(12;21)? t(9;22)? 11q23?

A
  1. Yes
  2. Yes
  3. No
    4 No

Pathology II Exam 3 (13 decks)

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