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Mercy CLS 6: Hematology > 19) Acute leukemias > Flashcards

19) Acute leukemias Flashcards

1
Q

define acute leukemia

A

malignant neoplastic proliferation of immature, nonfunctional hematopoietic cells in the BM

caused by clonal expansion from a single cell

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2
Q

acute leukemia leads to death from —— or ——- if untreated

A

infection
bleeding

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3
Q
  • adults
  • usually no lymphadenopathy
  • gum hypertrophy in some types
  • skin infiltration in some types
  • no mediastinal mass
  • DIC in some types
  • comparatively poor prognosis
A

AML

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4
Q
  • kids
  • lymphadenopathy
  • no gum hypertrophy
  • no skin infiltration
  • mediastinal mass in some cases
  • no DIC
  • comparatively good prognosis
A

ALL

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5
Q

——– like to infiltrate tissues from AML

A

monocytes

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6
Q

importance of classifying leukemias

A
  • anticipating clinical course
  • long term prognosis
  • appropriate therapy
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7
Q

gold standard diagnostic test for leukemia

A

immunophenotyping/flow

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8
Q

CD13
CD33

A

AML

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9
Q

blast marker

A

CD34

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10
Q

acute leukemias which do not show CD34

A
  • monocytic
  • acute promyelocytic
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11
Q

MPO +
Sudan black +
Specific esterase +

A

granulocytic AML

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12
Q

MPO +
Sudan black +
Nonspecific esterase +

A

monocytic AML

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13
Q

MPO =
Sudan black =
Esterase =

A

ALL

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14
Q

BM changes in AML

A
  • cellularity ↑ to 95-100%
  • ↑ M:E ratio
  • 20% or more blasts
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15
Q

agglomeration of primary granules

A

auer rods

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16
Q

auer rods rule out —— and suggest ——

A

ALL
AML

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17
Q

bunches of auer rods in a cell

A

acute promyelocytic leukemia

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18
Q

4 categories of AML variants as defined by WHO

A
  • AML with recurrent genetic abnormalities
  • therapy-related AML
  • AML with myelodysplasia-related changes
  • AML not otherwise specified
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19
Q

t(8;21)

A

AML with recurrent genetic abnormalities

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20
Q

“AML with recurrent genetic abnormalities” falls under past category of…

A

AML with maturation

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21
Q

myeloid sarcomas (+/=) in AML with recurrent genetic abnormalities

A

positive

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22
Q

AML that may have <20% blasts

A

AML with recurrent genetic abnormalities

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23
Q

AML with recurrent genetic abnormalities response to chemo

A

good

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24
Q

inv(16)

A

AML with abnormal eosinophils

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25
Q

CBFB-MYH11

A

inv(16)
AML with abnormal eosinophils

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26
Q

AML with abnormal eosinophils have —–% eos

A

> 5

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27
Q

how are eos in AML with abnormal eosinophils abnormal?

A

they have basophilic granules

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28
Q

AML with abnormal eosinophils prognosis

A

high rate of remission and survival

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29
Q

t(15;17)

A

acute promyelocytic leukemia

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30
Q

PML-RARA

A

t(15;17)
acute promyelocytic leukemia

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31
Q

best prognosis if treated, worst prognosis if untreated

A

acute promyelocytic leukemia

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32
Q

variant of acute promyelocytic leukemia harder to recognize and diagnose

A

microgranular variant

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33
Q

patients with acute promyelocytic leukemia may present with or develop…

A

DIC

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34
Q

acute promyelocytic leukemia tx

A

all trans-retinoic acid + chemo
causes pros to mature

35
Q

best to start tx even if this type of leukemia is only suspected

A

acute promyelocytic leukemia

36
Q

therapy-related AML usually occurs when?

A

10 years or so after chemotherapy for another cancer

37
Q

therapy-related AML prognosis

A

poor

38
Q

with therapy-related AML, risk increases with…

A

treatment age

39
Q

most common of the 4 variants of AML

A

AML with myelodysplasia-related changes

40
Q

AML with history of MDS and no history of chemo or radiation

A

AML with myelodysplasia-related changes

41
Q

AML with myelodysplasia-related changes prognosis

A

poor

42
Q

usually, MDS does not progress to…

A

ALL

43
Q

types of AML not otherwise specified

A

AML with minimal differentiation
AML without maturation
AML with maturation
Acute myelomonocytic leukemia
Acute monoblastic/monocytic leukemia

44
Q

AML with minimal differentiation (does/does not) have auer rods

A

does not

45
Q

AML without maturation (does/does not) have auer rods

A

does

46
Q

population for AML with minimal differentiation

A

infants
older adults (majority)

47
Q

AML with minimal differentiation
MPO/SBB
SE

A

MPO/SBB <3%
SE =

48
Q

AML without maturation
MPO/SBB
SE

A

MPO/SBB >3%
SE +

49
Q

population for AML without maturation

A

40s-50s

50
Q

AML with maturation
MPO/SBB
SE

A

MPO/SBB +
SE +

51
Q

AML with maturation (does/does not) have auer rods

A

does, in a range of granulocytic cells

52
Q

it’s important to distinguish AML ————- from acute promyelocytic

A

with maturation

53
Q

AML with maturation population

A

all ages

54
Q

acute myelomonocytic leukemia
MPO
SE
NSE

A

MPO +
SE +
NSE +/=

55
Q

population for acute myelomonocytic leukemia

A

all ages, median 50yo

56
Q

acute monocytic leukemia
MPO
SE
NSE

A

MPO =
SE =
NSE +/=

57
Q

monoblasts
nuclear lobation
irregular nuclear contours

A

acute monocytic leukemia

58
Q

may involve bleeding, and involvement of CNS and gums

A

acute monocytic leukemia

59
Q

young people get acute mono—— leukemia, adults get acute mono—–

A

blastic
cytic

60
Q

blast that lacks CD34

A

monoblast

61
Q

there is no specific —–blast marker
harder to dx

A

mono

62
Q

erythroblasts with round nuclei and agranular, possibly vacuolized blue cytoplasm

A

pure erythroid leukemia

63
Q

pure erythroid leukemia
MPO
NSE
PAS

A

MPO =
NSE +/=
PAS +

64
Q

CD71
CD117
glycophorin A
hemoglobin A

A

pure erythroid leukemia

65
Q

profound anemia
extremely rare
all ages

A

pure erythroid leukemia

66
Q

basophilic, agranular blasts with pseudopods/blebs

A

acute megakaryoblastic leukemia

67
Q

acute megakaryoblastic leukemia
MPO
SE
NSE
PAS

A

MPO =
SE =
NSE +/=
PAS +

68
Q

CD41
CD61

A

acute megakaryoblastic leukemia

69
Q

associated with Down syndrome
very poor prognosis

A

acute megakaryoblastic leukemia

70
Q

basophilic precursors with vacuolization

A

acute basophilic leukemia

71
Q

acute basophilic leukemia
MPO
SE
NSE
PAS

A

MPO =
SE =
NSE =
PAS +

72
Q

maybe the rarest acute leukemia

A

basophilic

73
Q

hyperhistaminemia
lytic lesions
cutaneous involvement

A

acute basophilic leukemia

74
Q

type of acute leukemia involving fibrosis of BM

A

acute panmyelosis with myelofibrosis

75
Q

acute panmyelosis with myelofibrosis involves ——— fibrosis, which is irreversible

A

collagen

76
Q

only —— can distinguish B from T ALLs

A

flow

77
Q

(T/B) ALL is more common

A

B

78
Q

acute leukemia with rare Philadelphia chromosome and relationship to CML

A

B-cell ALL

79
Q

B-cell ALL prognosis

A

95% long term survival in children
30-50% in adults

80
Q

TdT is only positive in ——-blasts

A

lympho

81
Q

mediastinal mass

A

T-cell ALL

82
Q

T-cell ALL is most common in…

A

adolescent males

83
Q

T-cell ALL prognosis is (worse/better) than B-cell

A

worse

Mercy CLS 6: Hematology (25 decks)

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