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MTAP 2 - HEMATOLOGY > 3RD HEMA - Part 2 > Flashcards

3RD HEMA - Part 2 Flashcards

1
Q

Overproduction of various types of immature or mature cells in the bone marrow and/or peripheral blood (in
most types of leukemia)

A

LEUKEMIAS

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2
Q

Frequently involves WBCs of the myelogenous or lymphocytic cell types

A

LEUKEMIAS

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3
Q

Malignant cells easily trespass the blood-brain barrier

A

LEUKEMIAS

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4
Q

Solid malignant tumors of the lymph nodes and related WBCs in the bone
tissue.

A

LYMPHOMAS

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5
Q

The distinctive cell type is the lymphocyte.

A

LYMPHOMAS

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6
Q

A neoplastic disease characterized by an overproduction of immature or mature cells of various WBC types in the bone marrow or peripheral blood

A

LEUKEMIA

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6
Q

Malignant cells are initially confined to the organs containing mononuclear
phagocytic cells such as lymph nodes, spleen, liver, and bone marrow.
Lymphomas can spill over into the circulating blood and demonstrate a
leukemic-appearing picture on a peripheral blood film.

A

LYMPHOMAS

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7
Q

● Bear in mind that other blood cells may also be involved:
- Sometimes affect the megakaryocytic line
- Erythroid line
- Commonly attributed to lymphocytes

A

LEUKEMIA

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8
Q

With Leukemia = M:E ratio of

A

10:1

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9
Q

Erythroid will become

A

RBC

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10
Q

Normal Ratio =

A

2:1 to 4:1

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11
Q

Myeloid will become

A

WBC

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12
Q

Type of anemia usually present in cases of acute leukemia:

A

Normocytic, Normochromic

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13
Q

More blasts: shorter, more fatal course of disease

A
  • ↑ WBC count with shift to the left
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14
Q

↑ Number of YOUNG forms of WBCs
(usually neutrophils)

A

Shift to the LEFT

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15
Q

● Described by symptoms of short duration

A

Acute Leukemias

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15
Q

2 kinds of cancer involving the WBC

A

○ Leukemia
○ Lymphoma

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15
Q

↑ Number of OLD forms of WBCs

A

Shift to the RIGHT

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16
Q

● Numerous immature cell forms in the bone marrow and/or peripheral blood

A

Acute Leukemias

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17
Q

● Described by symptoms of long duration

A

Chronic Leukemias

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18
Q

● Mostly mature cell forms in the bone
marrow and/or peripheral blood

A

Chronic Leukemias

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19
Q

● Total WBC counts range from extremely elevated to lower than
normal

A

Chronic Leukemias

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20
Q

● Increased total WBC count

A

Acute Leukemias

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21
Q

CLASSIFICATION OF LEUKEMIA: (2) NEW WAY

A

International Consensus Classification (ICC)

World Health Organization (WHO)

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21
Q

CLASSIFICATION OF LEUKEMIA: OLD WAY

A

French American British (FAB)

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22
Q

● An old system of classifying leukemia

● Based on
- Morphology of cells in Romanowsky-stained smear
- Cytologic and histochemical characteristics of cells involved

A

FRENCH-AMERICAN-BRITISH (FAB) CLASSIFICATION OF LEUKEMIA

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23
Q

Used in differentiating blasts
of AML from those of ALL

A

MYELOPEROXIDASE (MPO)

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23
Q

Examples of cytochemical stains used in FAB

A
  • Myeloperoxidase (MPO)
  • Sudan Black B
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24
Q

Enzyme found in primary granules of:

  • Neutrophils and Eosinophils
  • Monocytes (to a certain extent)
A

MYELOPEROXIDASE (MPO)

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24
Q

(+) Peroxidase stain rules
out ALL

A

MYELOPEROXIDASE (MPO)

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25
Q

Reactions parallel those of the MPO’s (in most cases)

Stains
- Sterols
- neutral fats,
- Phospholipids (found in the primary and secondary granules of neutrophils and lysosomal granules of monocytes)

A

SUDAN BLACK B (SBB)

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26
Q

most sensitive stain for granulocytic precursors

A

SUDAN BLACK B (SBB)

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27
Q

MYELOPEROXIDASE (MPO): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE

● Neutrophilic granules
(except normal blasts)
● Auer rods
● Leukemic blasts in FAB
M1, M2, & M3
● Eosinophils

A

POSITIVE

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28
Q

MYELOPEROXIDASE (MPO): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE

● Monocytes

A

WEAKLY POSITIVE or NEGATIVE

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29
Q

POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE

● Myeloblasts
● Basophils
● Lymphocytic cell series
● Erythrocytic cell series

A

NEGATIVE

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30
Q

SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE

● Promyelocyte,
myelocyte
● Leukemic blasts
● Auer rods
● Eosinophils

A

POSITIVE

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31
Q

SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE

● Metamyelocyte
● Bands
● Segmented neutrophils

A

STRONGLY POSITIVE

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32
Q

SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE

● Myeloblasts
● Monocytic cells

A

WEAKLY POSITIVE or NEGATIVE

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33
Q

SUDAN BLACK B (SBB): POSITIVE, WEAKLY POSITIVE, STRONGLY POSITIVE, NEGATIVE

● Lymphocytes and its precursors
● Megakaryocytes and platelets
● Erythrocytes

A

NEGATIVE

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34
Q

● COLOR: Depending on the method, peroxidase positive granules may produce a

A
  • Red-brown
  • Dark brown or
  • Black color
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35
Q

In one method, the RBCs develop diffusely ______ color because of pseudoperoxidase activity in hemoglobin.

A

brown

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36
Q

MYELOPEROXIDASE (MPO) STAINS

  • The substrate being used in one of the methods
  • A potential carcinogen.
A

3,3-diaminobenzidine (DAB) tetrahydrochloride

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37
Q
  • May be used to detect eosinophilic leukemia
  • Eosinophilic leukemia is poorly understood.
  • The peroxidase activity of eosinophils is different from
    that in other granulocytes because of the activity of the enzyme in the presence of sodium cyanide
A

Cyanide-resistant peroxidase stain

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38
Q

is sensitive to light. Smears should be stained immediately or kept in the dark.

A

Peroxidase enzyme

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39
Q

Smears that are older than __ weeks or that have been exposed to excessive light should not be reported as peroxidase negative.

A

2

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40
Q

● Wear protective clothing (including
gloves, lab coat, and mask when weighing out powders.
● For all pipetting, use mechanical aids.
● Clean up spills instantly.
● Wash hands properly after completion.
● Weigh benzidine in hood.

A

Precautions taken when handling DAB

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41
Q

may be performed on a specimen
that is several months old.

A

Sudan Black B stain

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42
Q

Reagents in SBB staining are ___ considered to be carcinogenic.

A

NOT

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43
Q

● Disadvantages of the SBB reaction:
- Time necessary to perform the stain (__ to __ hours)
- False-________ reactions are possible in disorders characterized by cytoplasmic lipid vacuoles (such as Burkitt’s lymphoma and occasionally, acute lymphocytic leukemia)
- ___________ background staining on bone marrow specimens (attributable to the fatty nature of the bone marrow itself)

A
  • Time necessary to perform the stain (1 to 2 hours)
  • False-positive reactions are possible in disorders characterized by cytoplasmic lipid vacuoles (such as Burkitt’s lymphoma and occasionally, acute lymphocytic leukemia)
  • Increased background staining on bone marrow specimens (attributable to the fatty nature of the bone marrow itself)
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44
Q

● Brownish-black cytoplasmic granules are seen in myelocytic precursors.
● Monocytes demonstrate few small brownish-black granules.
● Eosinophilic granules are brown and commonly demonstrate central pallor (granules are positive at their periphery with negative centers).
● Lymphoid cells rarely stain.

A

Effects of Sudan Black B (SBB)

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45
Q

LYMPHOCYTIC LEUKEMIA GENERAL RESULT: Myeloperoxidase

A

NEGATIVE

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46
Q

LYMPHOCYTIC LEUKEMIA GENERAL RESULT: Sudan Black B

A

NEGATIVE

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46
Q

Most common form of childhood leukemia

A

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

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47
Q

Patients:

70% of childhood ALL

A

L1

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48
Q

● Subtypes of ALL
- ALL L1
- ALL L2
- ALL L3 - “_____________”

A

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

L3 - Burkitt Type

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49
Q

● Classification:
- by FAB → 3 subtypes (L1, L2, L3)
- BY use of immunologic Markers

A

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

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50
Q

Patients:

70% of adult ALL

A

L2

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51
Q

Patients:

Rare in children and adults

A

L3

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52
Q

Immunologic markers:

CALLA (CD10)
TdT
CD19
CD20

A

L1

52
Q

Immunologic markers:

TdT

A

L2

53
Q

Immunologic markers:

sIg
CD19
CD20
CD22
CD24

A

L3

54
Q

Cell size:

Homogeneous population of
small blasts

A

L1

55
Q

Cell size:

Heterogeneous population of
large blasts

A

L2

55
Q

Nucleus:

Uniformly round, small

A

L1

56
Q

Cell size:

Homogeneous population of
large blasts (with nuclear and cytoplasmic vacuoles)

A

L3

57
Q

Nucleus: Irregular

A

L2

58
Q

Nucleus:

Round to oval

A

L3

59
Q

Nucleolus:

Single to
several

A

L2

60
Q

Nucleolus:

Single

A

L1

61
Q

Chromatin:

Slightly reticulate with perinucleolar clumping

A

L1

61
Q

Cytoplasm:

Scant, blue

A

L1

62
Q

Nucleolus:

Two to five

A

L3

63
Q

Chromatin:

Coarse with clear parachromatin

A

L3

63
Q

Chromatin:

Fine

A

L2

64
Q

Cytoplasm:

Moderate, pale

A

L2

65
Q

Cytoplasm:

Moderate, blue, prominently
vacuolated

A

L3

66
Q

Periodic acidSchiff (PAS)

L1 L2 L3

A

+ + -

67
Q

Methyl Green Pyronine

L1 L2 L3

A
    • +
68
Q

Oil Red O (ORO)

L1 L2 L3

A

+ + +

69
Q

L1, L2, L3

Both have TdT

A

L1 and L2

70
Q

L1, L2, L3

Both have
CD19
CD20

A

L1 and L3

71
Q

BY USE OF IMMUNOLOGIC MARKERS:

E rosettes - Surface Ig - Serum
Anti-ALL

T-ALL:

A

+ - -

72
Q

BY USE OF IMMUNOLOGIC MARKERS:

E rosettes - Surface Ig - Serum
Anti-ALL

Null ALL:

A
73
Q

BY USE OF IMMUNOLOGIC MARKERS:

E rosettes - Surface Ig - Serum
Anti-ALL

B-ALL:

A
    • -
74
Q

BY USE OF IMMUNOLOGIC MARKERS:

E rosettes - Surface Ig - Serum
Anti-ALL

Common ALL:

A
    • +
75
Q

Why is the MPO and SBB still needed?

A

● You may identify leukemic cells using a Wright stain but you can classify them using MPO and SBB
● In Oil Red O, all are positive but, reactions of L1 and L2 are only SOMETIMES observed.
● L3 is always positive with Oil Red O

76
Q

What particular type of cells have nuclear and cytoplasmic vacuoles?

A

L3

77
Q

● Manifestations:
- Persistent lymphocytosis

■ The lymphocyte count is always
increased

A

CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

78
Q

● Most common form of Leukemia in the elderly

A

CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

79
Q
  • Increased # of Smudge (Nuclear Remnants of Lymphocytes) and Rieder Cells (Lymphocytes w/
    cloverleaf-like nucleus)
A

CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

80
Q

● Examples of clinical variations of:
- Hairy Cell Leukemia
- Lymphosarcoma Cell Leukemia
- Prolymphocytic Leukemia

A

CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

80
Q

Reticulum Cell Sarcoma

A

Monocytic Leukemia

81
Q

Lymphoma, poorly-differentiated;
lymphocytic

A

Acute Lymphoblastic Leukemia (ALL)

82
Q

Lymphoma, well-differentiated;
lymphocytic

A

Chronic Lymphocytic Leukemia (CLL)

83
Q

What does the acronym PASS stand for?

A

Pull, Aim, Squeeze, Sweep

84
Q

Myeloma / Plasma Cell
Myeloma / Multiple Myeloma

A

Plasma Cell Leukemia

85
Q

Chloroma

A

Acute myelogenous Granulocytic Leukemia

86
Q

Lymphoma, undifferentiated

A

Stem Cell Leukemia

87
Q

What is the protein that can be found in patients with Plasma Cell Myeloma?

A

Bence-Jones Protein

88
Q

NON- LYMPHOCYTIC OR MYELOGENOUS LEUKEMIA
GENERAL RESULT: Myeloperoxidase

A

POSITIVE

89
Q

NON- LYMPHOCYTIC OR MYELOGENOUS LEUKEMIA
GENERAL RESULT: Sudan Black B

A

POSITIVE

90
Q

Myelocytic

AML, minimally differentiated
MPO (-)
SBB (-)

A

M0

91
Q

Myelocytic

AML without maturation
- Demonstrated auer rods which are linear projections of primary
granules

A

M1

92
Q

Myelocytic AML, with maturation

  • Most Common subtype
  • Has Auer rods
A

M2

93
Q

Myelocytic

Acute Promyelocytic Leukemia (APL)
- Faggot Cells (Bundles of auer rods)
- DIC
- Auer Rods

A

M3

94
Q

Myelocytic

APL, Microgranular Variant
- Cells have the characteristic
“butterfly”, “bowtie”, “coin-on-coin”, or “apple-core nuclei”

A

M3V

95
Q

Myelocytic
Monocytic

Acute Myelomonocytic Leukemia (AMML)
- Aka Naegeli Monocytic
Leukemia
- 2nd most common subtype of AML
- May demonstrate Auer rods M4E
- “AMML, with increased marrow
eosinophils

A

M4

96
Q

“AMoL poorly differentiated”

  • Seen in children
  • Demonstrate >80% monoblasts in the bone marrow
A

M5a

96
Q

Monocytic

Acute Monocytic Leukemia (AMoL)
- Aka Schilling
Leukemia

A

M5

97
Q
  • “AMML, with increased marrow
    eosinophils
A

M4E

98
Q

“AMoL, well differentiated”

  • Seen in middle-aged adults
  • Demonstrate <80% monoblasts in the bone marrow
A

M5b

99
Q

Erythrocytic
Myelocytic

Acute Erythroleukemia
- Aka DiGuglielmo’s Syndrome
- May demonstrate Auer rods

  • Type of anemia:
    macrocytic, normochromic.
  • This deviates from the typical
    pattern in which patients with
    acute myeloid leukemia (AML)
    exhibit normocytic, normochromic anemia.
A

M6

100
Q
  • Among the subtype of AML, it is only M__ that is (+) with Factor VIII stain
A

M7

100
Q
  • Erythroid cells in AML M6 are PAS strongly (+)
  • This is significant finding as
    erythroid cells are normally PAS (-)
A

M6

101
Q

Megakaryocytic

Acute Megakaryocytic Leukemia
- It requires immunocytochemical
al staining for accurate diagnosis

  • The immunocytochemical
    stain referred to is the Factor VIII
    stain (+)
A

M7

102
Q

Acute Basophilic Leukemia
- It is in Rodak’s and Turgeon
- It is not designated as AML
- It less occurring than other (M0 -
M7

A

M8

103
Q

What is the AML that has no maturation?

A

M1

104
Q

What is the AML that has maturation?

A

M2

104
Q

What is the other name of M4?

A

Naegeli Monocytic Leukemia

105
Q

What is the other name of Acute Monocytic Leukemia (M5)?

A

Schilling Leukemia

106
Q

How many AML demonstrate the presence of Auer rods?

A

5 = M1, M2, M3, M4, M6

107
Q

are derived from myelocytic cells, which is why they exhibit positive results for MPO, SSB, and SE.

A

AML M1-M3

107
Q

The following are Leukemias that are PAS (+)?

A

ALL - L1
ALL - L2
AML - M6

108
Q

What is the other name of AML M8?

A

Acute Basophilic Leukemia

109
Q

If myelocytic is the cell origin of leukemias, that kind of leukemia will test positive (+) for - (3)

A

“Myelocytic” = (+) → MPO, SSB, SE

myeloperoxidase, sudan black b, and specific esterase stain

109
Q

Other name for Acute Erythroleukemia (M6)

A

DiGuglielmo’s Syndrome

110
Q

Type of anemia for Acute Erythroleukemia (M6)

A

macrocytic, normochromic

110
Q

If monocytic is the cell origin of leukemias, that kind of leukemia will test positive (+) for - (2)

A

“Monocytic” = (+) → NSE (Butyrate), NSE (Acetate)

nonspecific butyrate and nonspecific esterase stain

111
Q

● In contrast, they yield negative results for NSE (butyrate) and NSE (esterase) due to the fact that NSE butyrate and esterase are specific to monocytic cells of origin

A

AML M1-M3

112
Q

● Also known as: Chronic granulocytic leukemia

A

CHRONIC MYELOGENOUS LEUKEMIA (CML)

112
Q

cell line exhibits myelocytic and monocytic characteristics as its cell of origin. Consequently, it will yield positive results for MPO, SSB, SE, NSE (butyrate), and NSE (acetate).

A

AML M4

112
Q

= only positive for Factor VIII

A

M7

113
Q

Characterized by the presence of Philadelphia Chromosome (Ph1)

A

CHRONIC MYELOGENOUS LEUKEMIA (CML)

114
Q

First described in 1960 by Peter C. Nowell, a faculty member of the University of Pennsylvania,
Philadelphia, as an unfamiliar small chromosome present in the WBCs of patients with CML

A

Philadelphia Chromosome (Ph1)

114
Q

Due to reciprocal translocation involving the long arms of chromosome 9 and 22 (results in the formation of the BCR-ABL1 fusion gene)

A

Philadelphia Chromosome (Ph1)

114
Q

● ____ of patients w/ CML have Ph1

○ Presence of Ph1 = ______ prognosis

A

● 90% of patients w/ CML have Ph1

○ Presence of Ph1 = goods prognosis

115
Q

● Three clinical phases of CHRONIC MYELOGENOUS LEUKEMIA (CML)

  • -
A
  • Chronic phase
  • Accelerated phase
  • Blast crisis
116
Q

CHRONIC MYELOGENOUS LEUKEMIA (CML) Must be differentiated from ___________ (LR)

A

leukemoid reaction

117
Q

is the likely outcome of a disease

A

Prognosis

118
Q

Though the presence of Ph1 indicates good prognosis, it is still not 100% good news for the patient because Ph1 chromosome means _______

A

cancer

118
Q

patient might die of disease, px may not get well leading to death

A

Poor prognosis

118
Q

patient might survive the disease

A

Good prognosis

119
Q

Due to reciprocal translocation involving the long
arms of chromosome __ and __ (results in the
formation of the BCR-ABL1 fusion gene)

A

9 and 22

120
Q

Three clinical phases:
- Chronic phase
- Accelerated phase
- Blast crisis

A

CHRONIC MYELOGENOUS LEUKEMIA (CML)

121
Q

THE 2022 ____ AND ____ classification of AML

A

ICC AND WHO

● ICC = International Consensus Classification
● WHO = World Health Organization

MTAP 2 - HEMATOLOGY (5 decks)

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