Acute Leukemias

Question 1

What is the main difference between acute and chronic leukemia?

Answer 1

Arrested development and Hiatus phase in acute leukemia

Question 2

ID how the stains would look in for myeloblasts,monoblasts,lymphoblasts,rubricytes and megakaryocytes in
MPO
SPe
NSe
SSe w/ NaF

Answer 2

MPO: myelo (+), mono (weak pos), lymph (-), rub/mega(-)
Spe: myelo (strong) mono (-) lymph, rub/mega (-)
NSe: myelo (weak pos) mono (strong pos) rest negative
NSe w NaF: myelo weak pos, rest negative

Question 3

Myeloperoxidase in MPO works on what specific type of cells?

Answer 3

phagocytic cells

Question 4

In classification of leukemias, what is the main difference between the FAB and WHO in classifications?

Answer 4

FAB used morphology while WHO used immunotype and genetic features for ID

Question 5

For the ICC (international consensus classification) what is the percentages for blasts or equivalents?

Answer 5

> 10% if recurrent genetic abnormalities
20% if not other specified

Question 6

Describe how immunophenotyping works with flow cytometry

Answer 6

it IDs the ag on the surface of the cell by reacting w monoclonal Abs to determine their lineage

Question 7

Describe myeloblastic leukemia without cytologic maturation (FAB M0), how does staining look?
age

Answer 7

> 20% blasts or equivalents
primitive blasts that show no myeloid features/lack reactivity with stains
requires flow or immunopheno
around 5% of adult AMLs (poor prog)
MPO NEG

Question 8

Describe acute myeloblastic anemia leukemia without maturation (FAB M1), how does staining look?
ages
wbc counts

Answer 8

little more mature than M0
>20% blasts or equiv
poss. auer rods
wbc 4000-300000
decreased pet
usually adults/neonates
MPO +, SPe +, Sse weak pos

Question 9

Describe acute myeloblastic leukemia w maturation (M2), how does staining work, what about translocation?
age
(hint..shift)

Answer 9

> 20% blasts/equiv
25% translocation with 8 and 21 chrom
maturation at promyelo and beyond
poss auer rods
25% of adult AMLs
Shift to the left + blasts

Question 10

T/F: in AML M2, there may not be a blast crisis or acute phase of chronic myeloid leukemia

Answer 10

false, in M2 there is a blast or crisis phase

Question 11

Describe acute promyelocytic leukemia acute myeloid leukemia w T(15:17), (M3 and M3m)
ages
possible disease correlation

Answer 11

> 20% blasts and pros
frequent auer rods
abnorm pros have heavy granules (M3) or no appearance of none (M3m) or both
usually in adults
very high WBC
DIC POSSIBLE

Question 12

T/F: In M3/M3m there is a thromboplastin effect that can initiate the coag cascade

Answer 12

true

Question 13

Describe the micro granular variant of M3m

Answer 13

so small granules
abnormal nuclear shape, H and N shaped
can be mistaken for AML or AMoL

Question 14

Describe acute monomyelocytic leukemia (M4)
age groups

Answer 14

> 20% blasts w mono/myelo
may have auer rods
high wbc
mostly adults
invasion of skin..etc due to monos
positive in all stains

Question 15

Describe acute myelomonocytic leukemia w Eosinophilia (M4e)

Answer 15

similar to M4 with marrow eos
>10% blasts
abn/immature
may be in peripheral

Question 16

Describe acute monoblastic/monocytic leukemia (M5)
ages

Answer 16

mostly children/young adults
infiltration of skin/gums
M5a –> >20% monoblasts poorly differentiated high wbc
M5b –> more mature, cytochem markers
Nse+

Question 17

Describe acute erythroid leukemia (M6)
whatkind of changes?

Answer 17

Pure eryth cells
used to be M6b
>80% marrow cellularity with eryth precursors
megaloblasTOID changes to rbcs/bizzar morph many nRBCs

Question 18

T/F M6 does not have a high MCV

Answer 18

False it does have high mcv

Question 19

describe acute megakaryoblastic leukemia (M7)
common?
cell lines
associated with?

Answer 19

RARE <1% of cases
>20% blasts (50% megakary in BM)
dysplastic features In all cell lines
assoc. w myelofibrosis
“dry-tap”

Question 20

Briefly describe acute basophilic leukemia

Answer 20

must distinguish from AML

Question 21

briefly describe leukemia of ambiguous lineage

Answer 21

both lymphs and myelos
mixed pop (bilineages)
bi-phenotypes

Question 22

briefly describe acute panmyeosis with myelofibrosis

Answer 22

malignancy un myeloid cell lines
BM fibrosis

Question 23

Describe acute lymphocytic leukemias (ALLs), Most common form
wbc ranges
staining

Answer 23

disease of children 2-10yrs
most common –> B cells
2nd peak in midlife
wbc above 100000> but 50% have norm or low
no auer rods
all stains negative
CNS infiltration common

Question 24

describe FAB L1

Answer 24

small lymphoblasts
little cytoplasms
occ cletting
MOST COMMON

Question 25

Describe FAB L2

Answer 25

large lymphs
irreg nucleus and cytoplasm
not cookie cutter (looks like reactive lymphs)

Question 26

describe L3,how do the cells look? (hint cytoplasm) how does testing look?

Answer 26

leukemic conversion of Burketts lymphoma
large blasts with basophilic cytoplasm
punch-out vacuoles
TdT negative
starry night pattern

Question 27

What is M0?

Answer 27

AML W/Out cytologic maturation/no staining

Question 28

What is M1? auer rods?

Answer 28

AML W out maturation (aeur rods)

Question 29

What is M2? Aeur rods? special extra words?

Answer 29

AML W maturation + left shift, blast crisis, can have auer rods

Question 30

What is M3? M3m? Auer rods? Trans location?

Answer 30

Acute PROlymph leukemia (DIC)
T(15,17) auer rods in doubles

Question 31

What is M4? Auer rods?

Answer 31

Acute monomyelo leukemia, can have aeur rods

Question 32

What is M5a? Aeur rods? types of cells? Differentiation?

Answer 32

Acute myelocytic leukemia, poor differentiation/blasts/pros Auer rods

Question 33

What is M5b?

Answer 33

AMol with differentiation (promonos/monos)

Question 34

What is M6? Aeur rods?

Answer 34

Erythroleukemia Nrbcs
No auer rods

Question 35

What is M7? Aeur rods?

Answer 35

Acute megakaryoblastic leukemia, no auer rods

Question 36

What is L1?

Answer 36

small blasts w small cytoplasm ALL

Question 37

What is L2?

Answer 37

Large blasts, look like reactive lymphs