1.6 Acute Leukemias

Question 1

Auer rods may be seen in all of the following except:

A. Acute myelomonocytic leukemia (M4)
B. Acute lymphoblastic leukemia (ALL)
C. Acute myeloid leukemia without maturation (AML:M1)
D. Acute promyelocytic leukemia (PML; M3)

Answer 1

Acute lymphoblastic leukemia (ALL)

Question 2

Which type of anemia is usually present in a patient with acute leukemia?

Answer 2

Normocytic, normochromic

Question 3

In leukemia, which term describes the peripheral blood finding of leukocytosis with a shift to the left, accompanied by NRBCs?

Answer 3

Leukoerythroblastosis

Question 4

The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except:

A. Replacement of normal marrow precursors by leukemic cells causing anemia
B. Decrease in functional leukocytes causing infection
C. Hemorrhage secondary to thrombocytopenia
D. Decreased erythropoietin production

Answer 4

Decreased erythropoietin production

Question 5

Which type of acute myeloid leukemia is called the true monocytic leukemia and follows an acute or subacute course characterized by monoblasts, promonocytes, and monocytes?

Answer 5

Acute monocytic leukemia

Question 6

In which age group does ALL occur with the highest frequency?

Answer 6

1–15 years

Question 7

Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia?

Answer 7

Acute promyelocytic leukemia (PML)

Question 8

An M:E ratio of 10:1 is most often seen in:

Answer 8

Leukemia

Question 9

Which of the following is a characteristic of Auer rods?

Answer 9

They are composed of azurophilic granules

Question 10

SITUATION: The following laboratory values are seen:

These results are most characteristic of:

Answer 10

Acute erythroid leukemia

Question 11

A 24-year-old man with Down syndrome presents with fever, pallor, lymphadenopathy, and hepatosplenomegaly. His CBC results are as follows:

These findings are suggestive of:

Answer 11

Acute lymphocytic leukemia

Question 12

SITUATION: A peripheral blood smear shows 75% blasts. These stain positive for both Sudan Black B (SBB) and peroxidase. Given these values, which of the following disorders is most likely?

Answer 12

Acute myelocytic leukemia (AML)

Question 13

In myeloid cells, the stain that selectively identifies phospholipid in the membranes of both primary and secondary granules is:

Answer 13

SBB

Question 14

Sodium fluoride may be added to the naphthyl ASD acetate (NASDA) esterase reaction. The fluoride is added to inhibit a positive reaction with:

Answer 14

Monocytes

Question 15

Leukemic lymphoblasts reacting with anti–common acute lymphoblastic leukemia antigen (anti-CALLA) are characteristically seen in:

Answer 15

Common ALL

Question 16

Which of the following reactions are often positive in ALL but are negative in AML?

A. TdT and PAS
B. Chloroacetate esterase and nonspecific esterase
C. SBB and peroxidase
D. New methylene blue and acid phosphatase

Answer 16

TdT and PAS

Question 17

A patient’s peripheral blood smear and bone marrow both show 70% blasts. These cells are negative on SBB staining. Given these data, which of the following is the most likely diagnosis?

Answer 17

ALL

Question 18

Which of the following leukemias are included in the 2008 World Health Organization classification of myeloproliferative neoplasms (MPN)?

A. CML
B. Chronic neutrophilic leukemia (CNL)
C. Chronic eosinophilic leukemia (CEL)
D. All of these options are classified as MPN

Answer 18

All of these options are classified as MPN

Question 19

In addition to morphology, cytochemistry, and immunophenotyping, the WHO classification of myelo- and lymphoproliferative disorders is based on which characteristic?

Answer 19

Cytogenetic abnormalities

Question 20

The WHO classification requires what percentage for the blast count in blood or bone marrow for the diagnosis of AML?

Answer 20

At least 20%

Question 21

What would be the most likely designation by the WHO for AML M2 by the FAB classification?

Answer 21

AML with t(8;21)

Question 22

What would be the most likely designation by the WHO for AML M3 by the FAB classification?

Answer 22

AML with t(15;17)

Question 23

Which AML cytogenetic abnormality is associated with AML M4 with marrow eosinophilia under the WHO classification of AML with recurrent genetic abnormalities?

Answer 23

AML with inv(16)

Question 24

What would be the most likely classification by the WHO for AML M7 by the FAB classification?

Answer 24

Acute megakaryoblastic leukemia classified under AML (not otherwise categorized)