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Hematology 2 - CEU MLS > Acute Leukemia > Flashcards

Acute Leukemia Flashcards

1
Q

Techniques in Identification of Acute Leukemia

A

▪ Morphologic and cytochemical stains
▪ Flow cytometry
▪ Genetic/molecular studies

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2
Q

French-American-British (FAB) Classifications of Acute Leukemia

A
  • Morphologic exam with cytochemical stain
  • Cytogenetic studies and T and B lymphocytes marker results
  • 30% blasts
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3
Q

WHO classification of Acute Leukemia

A
  • 20% blasts in BM
  • detect the presence/absence of genetic anomalies
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4
Q

Seen in patients with the blastic transformation of B and T cells

A

Acute Lymphoblastic Leukemia (ALL)

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5
Q

Most common leukemia in the
pediatric population (80%) vs. 20% of cases in adult

A

Acute Lymphoblastic Leukemia (ALL)

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6
Q

Treatment among adolescents and young adults is predominantly inspired by pediatric regimens with better survival rates

A

Acute Lymphoblastic Leukemia (ALL)

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7
Q

> 20% myeloid blasts

A

Acute Myelogenous Leukemia (AML)

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8
Q

Most common acute leukemia in adults

A

Acute Myelogenous Leukemia (AML)

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9
Q

most aggressive cancer with a variable prognosis depending upon the molecular subtypes

A

Acute Myelogenous/Myeloid Leukemia (AML)

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10
Q

Peak incidence of ALL in children

A

2 and 5 y/o

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11
Q

disease of childhood and adolescence, accounting for 25% of childhood cancers and up to 75% of childhood leukemia

A

ACUTE LYMPOBLASTIC LEUKEMIA (ALL)

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12
Q

T/F

In ALL, risk increases with age and most adult patients are older than 50 y/o

A

T

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13
Q

important prognostic indicator for survival of ALL

A

Subtype of ALL

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14
Q

WHO classification of ALL is synonymous with the? what are the classification?

A

FAB L1 and L2 classification

▪ Precursor B lymphoblastic leukemia/lymphoblastic lymphoma (precursor B-cell ALL) → neoplasm of lymphoblasts committed to the B-cell lineage
▪ Precursor T lymphoblastic leukemia/lymphoblastic lymphoma (precursor T-cell ALL) → neoplasm of lymphoblasts committed to the T-cell lineage

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15
Q

neoplasm of lymphoblasts committed to the B-cell lineage

A

Precursor B lymphoblastic leukemia/lymphoblastic lymphoma (precursor B-cell ALL)

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16
Q

neoplasm of lymphoblasts committed to the T-cell lineage

A

Precursor T lymphoblastic leukemia/lymphoblastic lymphoma (precursor T-cell ALL)

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17
Q

FAB Classification of ALL

A

L1 (children; homogenous)
L2 (older children and adults; heterogenous)
L3 (patients with leukemia secondary to Burkitt lymphoma)

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18
Q

size of blasts in L1

A

small

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19
Q

nuclear shape in L1

A

indistinct
regular with occasional cleft

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20
Q

nucleoli in L1

A

scant
rarely visible

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21
Q

cytoplasm in L1

A

invisible
moderately basophilic

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22
Q

One population of cells within the case

A

L1 (Homogenous)

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23
Q

chromatin pattern of L1

A

Homogeneous

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24
Q

size of blasts in L2

A

Large, heterogenous

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25
Q

nuclear shape in L2

A

CLEFFS/indented, prominent

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26
Q

nucleoli in L2

A

large, abundant (1 or more)

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27
Q

cytoplasm in L2

A

moderately clefted
varies in color

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28
Q

size of blasts in L3

A

large; homogenous size

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29
Q

nuclear shape in L3

A

round/oval

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30
Q

nucleoli in L3

A

1-3 prominent, basophilic

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31
Q

cytoplasm of L3

A

prominent, vacuoles
deeply basophilic

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32
Q

L3 is aka

A

Burkitt Lymphoma type

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33
Q

CLINICAL SIGNS AND SYMPTOMS OF ALL that varies from days to weeks

A

▪ Pain in the extremities (legs) - tissue infiltration of leukemic cells
▪ Lymphadenopathy and hepatomegaly - 75%
▪ Leukemic meningitis and cranial nerve palsies - nerve infiltration by leukemic blasts

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34
Q

Total leukocyte count of ALL in 60-70% pt.

A

50-100 × 10^9/L

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35
Q

Total leukocyte count of ALL in <15% pt.

A

> 100 × 10^9/L
extreme leukocytosis

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36
Q

Total leukocyte count of ALL in 25% pt.

A

leukocytopenia

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37
Q

Peripheral Blood Smear of ALL

A

Predominance of Blast cell
Close to 100% lymphoblasts, lymphocytes & smudge cells

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38
Q

most reliable indicators of a cell’s origin for ALL

A

Immunophenotyping
Genetic analysis

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39
Q

characterize Lymphoid progenitors (B and T)

A

CD34
Terminal deoxynucleotidyl transferase (TdT)
Human leukocyte antigen-DR subregion (HLA-DR)

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40
Q

characterized by specific B cell antigens that are expressed at different stages of B cell development

A

B-ALL

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41
Q

ALL subtypes

A

Early (pro/pre-pre) B-ALL

Intermediate (common) B-ALL

Pre-B-ALL

T-ALL

42
Q

Immunophenotype of Early (pro/pre-pre) B-ALL

A

CD34
CD19
cytoplasmic CD22
TdT

43
Q

Immunophenotype of Intermediate (common) B-ALL

A

CD34
CD19
cytoplasmic CD22
TdT
CD10*

44
Q

Immunophenotype of Pre-B-ALL

A

CD34
CD19
cytoplasmic CD22
TdT (variable)*
cytoplasmic u*

45
Q

Immunophenotype of T-ALL

A

CD2
CD3
CD4
CD5
CD7
CD8
TdT

46
Q

seen in the majority of B and T cell ALL, which produce changes that affect normal B and T cell development and underlie the pathogenesis of these neoplasms

A

Cytogenetic abnormalities

47
Q

alters the Notch receptor signaling pathway (responsible for normal T cell development)

A

T-ALL- gain of NOTCH1 gene

48
Q

has the worst prognosis among ALLs

A

B-lymphoblastic leukemia/lymphoma with t(9;22)(q34;q11.2);
BCR-ABL1 mutation (Philadelphia chromosome–positive ALL)

49
Q

Nonspecific, decreased production of normal BM elements

A

ACUTE MYELOID LEUKEMIA (AML)

50
Q

CLINICAL SIGNS AND SYMPTOMS OF AML

A

▪ Pallor, fatigue, fever, bruising, and bleeding
▪ Anemia
▪ Thrombocytopenia
▪ Neutropenia
▪ Splenomegaly
▪ DIC and other bleeding abnormalities
▪ malignant cell infiltration in gums and mucosal site

51
Q

AML WBC count

A

5 -30 x 10^9/L

52
Q

present in the PBS in AML

A

Myeloblasts

53
Q

Common abnormalities in lab test with AML

A

Hyperuricemia – caused by increased cellular turnover
Hyperphosphatemia – due to cell lysis
Hypocalcemia – latter two are involved in progressive destruction
Hypokalemia – also common at presentation

54
Q

Caused by the breakdown products of dying cancer cells? which causes?

A

Tumor lysis syndrome

acute uric acid nephropathy
renal failure

55
Q

FAB Classification of AML

A

M0 (Myeloid)
M1 (Myeloid)
M2 (Myeloid)
M3 (Promyelocytic)
M4 (Myelomonocytic)
M5 (Monocytic)
M6 (Erythroleukemia)
M7 (Megakaryocytic)

56
Q

Undifferentiated blasts, AML— not otherwise categorized

A

M0 (Myeloid)

57
Q

Blasts and promyelocytes predominate without further maturation of myeloid cells.

What is the WHO synonym?

A

M1 (Myeloid)

WHO: Acute Myeloid Leukemia WITHOUT Maturation

58
Q

Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage.

What is the WHO synonym?

A

M2 (Myeloid)

WHO: Acute Myeloid Leukemia WITH Maturation

59
Q

Promyelocytes predominate in the bone marrow.

What is the WHO synonym?

A

M3 (Promyelocytic)

WHO: Acute Promyelocytic Leukemia

60
Q

Both myeloid and monocytic cells are present to the extent of at least 20% of the total leukocytes

What is the WHO synonym?

A

M4 (Myelomonocytic)

WHO: Acute Myelomonocytic Leukemia

61
Q

M4 is aka

A

Naegeli type Monocytic Leukemia

62
Q

Most cells are monocytic with 2 subtypes (a and b)

What is the WHO synonym?

A

M5 (Monocytic)

WHO:
Acute Monoblastic Leukemia (FAB M5a)
Acute Monocytic Leukemia (FAB M5b)

63
Q

characterized by large blasts in bone marrow and peripheral blood; common in young adults

A

FAB M5a

64
Q

differentiated type by monoblasts, promonocytes, and monocytes; common during middle age

A

FAB M5b

65
Q

Refered to as Schilling’s type

A

M5 (Monocytic)

66
Q

aka M6 (Erythroleukemia)

A

Erythemic Myelosis
Di Guglielmo syndrome

67
Q

Abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations

What is the WHO synonym?

A

M6 (Erythroleukemia)

WHO: Acute Erythroid Leukemia

68
Q

Large and small megakaryoblasts with a high nuclear cytoplasmic ratio; Pale; agranular cytoplasm

What is the WHO synonym?

A

M7 (Megakaryocytic)

WHO: Acute Megakaryoblastic Leukemia

69
Q

WHO Classification of AML

A

ACUTE MYELOID LEUKEMIA WITH CERTAIN GENETIC ABNORMALITIES

ACUTE MYELOID LEUKEMIA, NOT OTHERWISE SPECIFIED

ACUTE LEUKEMIAS OF AMBIGUOUS LINEAGE

70
Q

WHO Classification: ACUTE MYELOID LEUKEMIA WITH CERTAIN GENETIC ABNORMALITIES

A

AML with t(8;21)
AML with inv(16) or t(16;16)
AML with t(9;11)
APL with t(15;17)

71
Q

WHO Classification: ACUTE MYELOID LEUKEMIA, NOT OTHERWISE SPECIFIED

A

AML with minimal differentiation
AML without maturation
AML with maturation
Acute myelomonocytic leukemia
Acute monoblastic/monocytic leukemia
Acute erythroid leukemia
Acute megakaryoblastic/megakaryocytuc leukemia
Acute basophilic leukemia

72
Q

WHO Classification: ACUTE LEUKEMIAS OF AMBIGUOUS LINEAGE

A

Acute undifferentiated leukemia
Mixed phenotype acute leukemia with t(9;22)
Mixed phenotype acute leukemia with t(v;11q23)
Mixed phenotype acute leukemia, B lymphocytes-myeloid cells
Mixed phenotype acute leukemia, T-myeloid

73
Q

CYTOCHEMICAL STAINS

A

MYELOPEROXIDASE
SUDAN BLACK B
CHLOROACETATE ESTERASE (NAPTHOL AS-D) - SPECIFIC ESTERASE
NON-SPECIFIC ESTERASE
PERIODIC ACID SCHIFF (PAS)
ACID PHOSPHATASE STAIN
TERMINAL DEOXYRIBONUCLEOTIDYL TRANSFERASE (TdT)
TOLUIDINE BLUE / METACHROMATIC STAIN

74
Q

stain used to differentiate AML (+) to ALL (-)

A

MYELOPEROXIDASE
SUDAN BLACK B

75
Q

stain must be FRESH because enzymes are unstable

A

MYELOPEROXIDASE

76
Q

MYELOPEROXIDASE is a marker for

A

Auer Rods
(due to primary granules)

77
Q

(+) result in MPO

A

black precipitate or reddish brown (Phi bodies) –> AML

78
Q

Stains lipids & phospholipids

A

SUDAN BLACK B

79
Q

Stain prepared as Air dry and Fresh can be both used

A

SUDAN BLACK B

80
Q

(+) result of SUDAN BLACK B

A

black –> AML

81
Q

Stains granulocytic lineage

A

CHLOROACETATE ESTERASE (NAPTHOL AS-D/SPECIFIC ESTERASE

82
Q

stain that differentiate granulocytic leukemia (+) from monocytic leukemia (-)? what is the positive result?

A

CHLOROACETATE ESTERASE (NAPTHOL AS-D)

(+): red granules

83
Q

Stains monocytic lineage including megakaryocytes and macrophage

A

NON-SPECIFIC ESTERASE

84
Q

Stains used to differentiate monocytic leukemia from granulocytic leukemia

A

CHLOROACETATE ESTERASE (NAPTHOL AS-D)
NON-SPECIFIC ESTERASE

85
Q

To differentiate monocytic leukemia from granulocytic leukemia in NSE, these are used:

A

✓ α-naphthyl acetate esterase
✓ Sodium Fluoride – added to inhibit monocytic series
✓ α-naphthyl butyrate esterase

86
Q

stains monocyte, plasma cell, and megakaryocyte as (+) red brown

A

α-naphthyl acetate esterase

87
Q

stains monocytic series with (+) dark red precipitate

A

α-naphthyl butyrate esterase

88
Q

Stains most carbohydrates in all red cells except PRONORMOBLAST

A

PERIODIC ACID SCHIFF (PAS)

89
Q

PERIODIC ACID SCHIFF (PAS) is useful for

A

AML M6 or Erythroleukemia

90
Q

(+) result of PAS? what are the stained cells?

A

magenta or purple

Basophils, lymphocytic series, plasma cells, erythrocytic cell series

91
Q

Stains ACP found in lysosomes in myelocytic lineage and lymphocytic lineage

A

ACID PHOSPHATASE STAIN

92
Q

used in ACID PHOSPHATASE STAIN to stain purple to red granules

A

heparin

93
Q

used to identify Hairy Cell Leukemia which is resistant to L-tartrate (TRAP) in ACP stain

A

Tartaric acid

94
Q

(+) result of ACP stain

A

purple to red granules

95
Q

Can stain ALL due to polymerase immunoperoxidase

A

TERMINAL DEOXYRIBONUCLEOTIDYL TRANSFERASE (TdT)

96
Q

differentiate ALL (+) to AML (-)

A

TERMINAL DEOXYRIBONUCLEOTIDYL TRANSFERASE (TdT)

97
Q

Stains acid mucopolysaccharide of mast cells and basophils

A

TOLUIDINE BLUE / METACHROMATIC STAIN

98
Q

Compare AML (M1,M2, M3) from AMML (M4) using stains

A

BOTH +: MPO, SBB, SE
BOTH -: Factor VIII

AML (M1,M2, M3) NEGATIVE: NSE
AMML (M4) POSITIVE: NSE

99
Q

result of stain in AML (M5)

A

MPO, SE, Factor VIII: -
NSE: +
SBB: -/+

100
Q

result of stain in M6 (erythroleukemia)

A

MPO, SBB, SE: + myelo, - normo
NSE, Factor VIII: -

101
Q

result of stain in M7 (megakaryocytic)

A

MPO, SBB, SE, alpha-naphthyl butyrate esterase: -
alpha-naphthyl acetate esterase: + localized
factor VIII: +

Hematology 2 - CEU MLS (4 decks)

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