Acute Leukemias

Question 1

ALL target population

Answer 1

Children

Male more than female s

Question 2

ALL curability

Answer 2

Curable in 70% children

Bad in adults

Question 3

AML Target

Answer 3

Adults

Male more than female

Question 4

Curability AML

Answer 4

Low in adults

Question 5

Causes of acute leukemia

Answer 5

Idiopathic 
Underlying hemato disorders
Chemical 
Drugs 
Ionizing radiation
 Viruses - HTLV1, EBV, HIV
Genetic conditions ( fanconi anemias, Down syndrome, ataxia telangiectasia)

Question 6

What is a blast cell

Answer 6

Precursor cells arrested in an early stage of development

Question 7

What is the pathophysiology of acute leukemia’s

Answer 7

Chromosomal translocation -> Abnormal expression of gene -> blast cells replace normal bone marrow -> anemia, neutropenia, thrombocytopenia

Question 8

High amount of blast cells invade vital organs , what are the consequences

Answer 8

hyperleukocytosis
Increase in blood viscosity
Microthrombi, acute bleeding

Question 9

Organs invaded by blast cells

Answer 9

Brain
Lungs
Eyes
Kidney 
Spleen

Question 10

Metabolic manifestaction of acute leukemia

Answer 10

Hyponatremia due to vasopressin like element

Hypokalemia

Hyperuricemia

Question 11

clinical manifestation of acute leukemia’s due to

Answer 11

Marrow failure
Leukostasis
Tissue infiltration

Question 12

Clinical manifestation of acute leukemia

Answer 12

Fever
Weight loss
Gum hypertrophy
Dic 
Lymphadenopathy 
hepatosplenomegaly 
Petechiae
 confusion

Question 13

Classification of acute lymphoblastic leukemia FAB

Answer 13

L-1 85%
L-2 14%
L-3 (Burkitt ) 1%

Question 14

L1 characteristic

Answer 14

Small monomorphic type
Small homogeneous blasts
single and conspicuous nucleolus
Regular nuclear outline

Question 15

L2 characteristics

Answer 15

Large heterogeneous typ
large blasts
more pleomorphic

Question 16

L3 characteristics

Answer 16

Burkitt cell type

Blast cell with basophilic and vacuolated cytoplasm

Question 17

ALL classification WHO

Answer 17

Precursor B cell
Precursor T cell
Burkitt cell leukemia

Question 18

AML classification WHO

Answer 18

AML With recurrent genetic abnormalities
AML with multilineage dysplasia
AML therapy related
AML not otherwise categorized

Question 19

AML FAB classification

Answer 19

M0- minimally differentiated 
M1- without maturation 
M2- wirh maturation 
M4-myelomonocytic
M5- monoblastic / monocytic
M6- erythroid 
M7- megakaryoblastic

Basophilic
Acute oanmyelosis with myelofibrosis
Myeloid sarcoma

Question 20

Diagnosis

Answer 20

FBC 
Normocytic anemia 
High WBC 
Blast in peripheral blood 
Thrombocytopenia 
DIC 
BONE MARROW with more than 20% blasts

Question 21

How to distinguish AML FROM ALL

Answer 21

Light micro - AML-> auer rods, cytoplasmic , granules . ALL-> no auer rods, no granules
Flow cytometry in immunophenotyping
special stains - cytochemical staining peroxidase (+ AML ) , periodic acid Schiff (+ALL) , acid phosphatase (+ T-ALL)

ALL -> small basts , scant cytoplasm, dense chromatin, indistinct nucleoli, no auer rods

AML -> large blast, moderate cytoplasm , fine and lacy chromatin , prominent nucleoli, presence of auer rods

Question 22

Common antigens in AML

Answer 22

Cd13
Cd33
Cd117

Question 23

Common antigens in B- ALL

Answer 23

Cd10
Cd19
Cd22

Question 24

Common antigens T-ALL

Answer 24

Cd3

Cd7

Question 25

Type of chromosome type gives very poor prognosis in ALL

Answer 25

Philadelphia chromosome t(9:22)

Question 26

Common chromosome abnormalities

Answer 26

``` AML M2 - t(8:21) AML m3 - t(15:17) AML M4 - Inv16 T(9:22) ALL, CML T(8:14) b-ALL ```