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Hematology > Acute Leukemias > Flashcards

Acute Leukemias Flashcards

1
Q

Acute Leukemias

A

stem cell disorders characterized by malignant neoplastic proliferation & accumulation of immature & nonfunctional hematopoietic cells in the BM

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2
Q

Acute Leukemia General Characteristics

A

Abrupt onset & progresses rapidly
symptoms are related to the anemia, thrombocytopenia &/or neutropenia
BLASTS ARE ALMOST ALWAYS FOUND IN PB
2 categories

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3
Q

AML vs ALL

A

AML- affects the maturation of myeloid stem cells

ALL- affects the lymphoid progenitor

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4
Q

Acute Leukemia FAB criteria

A

morphological & cytochemical evaluation

>30% blasts

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5
Q

Acute Leukemia WHO criteria

A

morphology, cytogenetics, molecular genetics, & immunologic markers
>20% blasts

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6
Q

Acute Lymphoblastic Leukemias

A

malignant lymphocytes that do not mature & do not undergo apoptosis

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7
Q

Epidemiology of ALL

A

L1 - most common leukemia of children

L2 & L3 - seen in children & adults

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8
Q

ALL clinical Findings

A 
normo, normo anemia
thrombocytopenia
bone pain
usually neutropenia
WBC - increased, normal, decreased
LYMPHOBLASTS - no auer rods & scant cytoplasm
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9
Q

ALL BM findings

A

hypercellular

>20% lymphoblasts

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10
Q

ALL stain reactions

A

myeloperoxidase -
sudan black B -
chloroacetate esterase -

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11
Q

ALL L1 General Characteristics

A

most common ALL in children - peak age is 2-6
best prognosis
majority of ALL cases

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12
Q

ALL L1 Morphology

A

lymphoblasts predominantly small (2x mature lymph)
nuclear shape is regular
nucleoli are NOT prominent
cytoplasm is scant & only moderately basophilic

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13
Q

ALL L2 General Characteristics

A

most frequent ALL found in adults

large lymphoblasts

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14
Q

ALL L2 morphology

A

LARGE lymphoblasts
nuclear shape is irregular w/ indentations
nucleoli are large & prominent
cytoplasm size & color is variable

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15
Q

ALL L3 General Characteristics

A

rarest form of ALL
known as BURKITT’S lymphoma/leukemia
presents more often as a lymphoma
occurs in both children & adults

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16
Q

ALL L3 morphology

A 
Large lymphoblasts
nuclear shape is regular
nucleoli is prominent
cytoplasm is abundant & deeply basophilic
VACUOLIZATION
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17
Q

WHO classification of ALL

A
  1. precursor B & precursor T cell neoplasms

2. Burkitt type (L3)

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18
Q

Precursor B-Cell Leukemia

A

B-Cell ALL or B-ALL
80-85% of ALL cases in children
70% of cases in adults

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19
Q

B-ALL characteristics

A

B lymphoblasts - TdT +, HLA-DR +, CD19+
B-ALL w/ CD10 + have best prognosis
cytogenetic abnormalities include : translocation, hypodiploidy, hyperdiploidy

20
Q

Translocation

A

2 broken off chromosome pieces of chromosomes are exchanged

most common translocation in childhood B-ALL : t(12;21)

21
Q

Hypodiploidy

A 
# of chromosomes per cell that is less than 2n
30-39
22
Q

Hyperdiploidy

A

of chromosomes per cell is more than 2n

23
Q

B-ALL prognosis

A

usually good
children complete remission rate is 95%
adults - 60-85%

24
Q

Precursor T-Cell Leukemia

A

T-ALL
15% of children ALL/ 25% of adults
high WBC
Lymphoblasts are more variable in size & cytoplasmic vacuoles may be present

25
Q

T-ALL clinical findings

A

Lymphoblasts are TdT+, CD7+ , CD3+

cytogenetic - translocations

26
Q

Acute Myeloid Leukemia General Characteristics

A

affects CFU-GEMM
affects neutrophils, platelets, RBCs, monocytes
common in infants & older adults
rapidly fatal if not treated

27
Q

AML PB lab findings

A

WBC - increased, normal, decreased
anemia
thrombocytopenia
BLASTS- auer rods common

28
Q

AML BM lab findings

A

hypercellular w/ decreased fat content

predominance of blasts - auer rods present

29
Q

Acute Myeloblastic Leukemia (M0)

A

rare
myeloblasts w/o granules
myeloperoxidase & sudan black B - negative

30
Q

Acute Myeloblastic Leukemia w/ Minimal Maturation (M1)

A

common (20%)
myeloblasts w/ or w/o scant granules, auer rods can be present
myeloperoxidase & sudan black b - POSITIVE

31
Q

Acute Myeloblastic Leukemia w/ Maturation (M2)

A

most common (30%)
myeloblasts w/ granules, promyelocytes & few myelocytes
auer rods present
myeloperoxidase & sudan black b - POSITIVE

32
Q

Acute Promyelocytic Leukemia (M3)

A

15% of AML
myeloblasts, promyelocytes w/ prominent granules
auer rods common
faggot cells- multiple Auer rods occurring in bundles

33
Q

Acute Promyelocytic Leukemia (M3) Stain reactions

A

myeloperoxidase & sudan black b - POSITIVE
specific esterase - positive
nonspecific esterase - negative

34
Q

Acute Myelomonocytic Leukemia (M4)

A

20% of AML
myeloblasts & promyelocytes >30% marrow cells
promonocytes & monoblasts >20%
auer rods may be present

35
Q

Acute Myelomonocytic Leukemia (M4) Stain reactions

A

myeloperoxidase & sudan black b - POSITIVE
specific esterase - positive
nonspecific esterase - positive

36
Q

Acute Myelomonocytic Leukemia w/ Eosinophilia (M4eo)

A

same as M4 w/ >5% abnormal eosinophils

37
Q

Acute Monoblastic Leukemia w/o Differentiation (M5a)

A

5-15% of cases
large monoblasts w/ lacy nuclear chromatin & abundant cytoplasm
Specific esterase - negative
nonspecific esterase- positive

38
Q

Acute Monoblastic Leukemia w/ Differentiation (M5b)

A

monoblasts, promonocytes, blood monocytosis
specific esterase - negative
nonspecific esterase - positive

39
Q

Acute Erythroleukemia (M6)

A

rare
erythroid blast (pronormoblasts) & precursors >50%
PB: poikilocytosis & anisocytosis

40
Q

Acute Erythroleukemia (M6) Stain reactions

A

myeloperoxidase & sudan black b - positive
specific esterase - positive
PAS - POSITIVE

41
Q

Megakaryocytic Leukemia (M7)

A

rare
megakaryoblasts, possible cytoplasmic budding
myeloperoxidase & sudan black b negative

42
Q

WHO AML classifications

A
  1. AML w/ characteristic/ recurrent genetic abnormalities
  2. AML w/ multilineage dysplasia
  3. AML & MDS; therapy related
  4. AML not otherwise categorized (all of FAB)
43
Q

AML w/ characteristic genetic abnormalities

A

better prognosis
translocations: t(8;21), t(15;17)
inversions in chromosomes: inv(16)
11q23 abnormalities

44
Q

AML w/ multilineage dysplasia

A

prior MDS or MPD that transforms into AML

most often in elderly patients & often worse prognosis

45
Q

AML & MDS therapy related

A

prior chemo &/or radiation and subsequently develop AML or MDS
often carry a worse prognosis

46
Q

AML not otherwise categorized

A

includes all of FAB classification

Hematology (14 decks)

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