ALL, CLL, HCL Flashcards
differentiate between AML, ALL
1_AML: myeloblast, big people, big blasts, lots of nucleoli, lots of cytoplasm, lots of granules, aur rods, big toxicity, big mortality rate, MPO+, SBB+
2_ALL: lymphoblast, small people, small blasts, little cytoplasm, little nucleoli, no granules, little toxicity of treatment, little mortality rate, PAS+
in cytochemistry, which cells exhibit: 1_MPO, SBB 2_Non specific estrase 3_block positivity of PAS 4_Acid phosphatase 5_Acid estrase
1_M1_M3 2_M4, M5 3_M6 4_M7,TALL, HCL 5_Histyocytic leukemia
in which cases immunophenotyping is diagnostic?
1_essential for diagnosis of M0&M7
2_define ALL lineage
3_Biphenotypic leukemia
4_charachterize a phenotype for MRD detection
Mention the basic panels of Abs
1_T. lineage: CD3+_CD, 2,5,7. (CD4,8 to exclude residual normal T cells). 2_B. lineage: CD22+-CD 19 CD 10 for CALL. 3_Myeiloid markers: CD 13,33,MPO to exclude M0 and diagnose Biphenotypic. CD 14,15 for M4,5. CD 41,61:M7 4_
Mention the signs and symptoms of ALL
1_Anemia 2_leukopenia 3_thrombocytopenia 4_weight loss 5_LAP, HSM
What are the tecniques used to diagnose ALL
1_morphological features: Romanowsky stained BM
2_cytochemistrt
3_cytogenitics
4_immunophenotyping
Mention the morphological classifications of ALL
L1: small cell , homogenous population, common in childhood, most common type, best prognosis
L2:large cell, hetregenous population, common in adult, may be confused with blasts of AML
L3:Burkitts cell, large cell, homogenous population, poor prognosis, B cell mailignancies
what’s the eitology of ALL
1_immun deficiency 2_genitic factor 3_ionizing radiation, electromagnetic field 4_chemicals 5_infections
what is All
a malignancy of lymphopiotic cell manifested by slow but uncontrolled growth of abnormal poorly defferintiated lymphoid cells
Mention the immunological classification of ALL
1_T. cell: CD3,2,5,7.50%of pt have Mediastinal mass.
2_B. cell: +SIg,-TdT, usually L3
3_pre B cells:+HLA. DR, TdT, CD 19,20,24.
4_CALL(pro. B):+HLA, DR, CD10,19,24,20.
has the highst remission rate
mention the complications of ALL
1_infection; most common cause of death. 2_bleeding 3_meningeal leukemia 4_testicular infiltration 5_leukostasis
Mention the markers and thier results in different ALL subtypes.
type. Tdt.CAll.CD7.CD19.DR.M
1_CALL. + + - + + L1,2
2_PRE B. + + - + + L1
3_B CELL. - - - + + L3
4_T CELL. + - + - - L1,2
what are the main characters of CLL
1_most common leukemia in west
2_more common in whites, old men
3_lymphocytosis> 5000
Mention the signs and symptoms of CLL
1_symmetrical LN enlargement
2_hemolytic anemia
3_thrombocytopenia
4_HSM
5_Infections due to: impaired Ig production, Neutropenia, corticosteroids.
6_infiltration: skin, tonsill, CNS, bone, joint
What are tha lab findings in CLL
1_leukocytosis with lymphocytes 50000_200000
2_neutrophils: normal in early stage then reduced
3_HB normal early then decrease
4_normocytic normochromic anemia
5_spherocytosis, reticulocytosis,+coomb test
6_thrombocytopenia
7_hypoimmunoglobenimia
8_in blood film; monotonous cells, smear cells.
9_chromosomal abnormalities in 50% «trisomy 12»
10_CD 5 antigen
Write the Rai classification of CLL
S0: lymphocytosis> 10000 in blood,> 30% in, BM. «15 y» S1 0+LAP. «5_9 y» S2 1+organomegaly. «5_9» S3 2+Anemia «2» S4 3+thrombocytopenia «2»
stage 0_ 2low risk
stage 3_4 high risk u
Write the Bient classification of CLL
A.< 3 involved areas, Hb>10,platlete > 100
B.> 3,Hb same as A
C.any number of involved areas with Hb <10,plat <100
What is the DDX of CLL
1_prolymphocytic leukemia 2_HCL 3_large granular lymphocytic leukemia 4_leukemic phase of NHL (follicular, mantle) 5_Waldenstroms macroglobulenimia
Mention the lab findings in ALL
1_Leukocytosis in 75% of ptn, blast cells, the pb contain 100% lymphoblasts, lymphocytes, smudge cells.
2_BM: hypercellular, infiltration with lymphoid cells «more than 30 blasts», fibrosis may occur
3_Anemia, thrombocytopenia.
explain some charecters of prolymphocytic leukemia.
rare form.
can arise or transform from CLL
lymphoid cells are larger and less mature.
in old males
leukocytosis> 100k
associated with splenomegaly but not particulary with LAP
poor prognosis
explain some charecters of HCL
median age, M> F. Pancytopenia. prominent splenomegaly. dry tap very indolent. pb: mononuclear with hairy cytoplasmic projections.
what will be the blood picture in HCL
1_pancytopenia 2_normocytic normochromic anemia 3_leukopenia 4_plat decrease 5_most cases belong to the B cell lineage. 6_HC 10_50%
what is the result of cytochemistry and immunophenotyping in HCL
tartrate resistance and Acid phosphatase +
CD 11,25,103
Mention the complications of CLL
1_hyperleukocytosis, Hypogammaglobulinemia
2_Anemia
3_thrombocytopenia
4_Autoimmunity
5_transformation to large cell lymphoma, pll, ALL, MM
What is MDS
it is a hetreogenous group of clonal hematopoietic stem cell disorders charachterized by:
ineffective heamtopoisis
peripheral cytopenia
what is the classification of MDS.
1_refractory anemia: dimorphic population,< 5%blast, AML in 10%
2_RA with sideroblasts: 15% sideroblasts,< 5%blasts
3_RAEB: 5_20% blasts, AML in, 35%.
4_RAEB. T: 21_30% blasts, AML in65%
5_CMML: anemia, thrombocytopenia, monocytosis, splenomegaly, AML in 30%
what are the causes of leukemoid reactions?
myeloid:
1_infection
2_non hematological malignancy
3_acute hemolysis
lymphoid: 1_cancer 2_TB 3_infectious mononucleosis 4_cytomegalovirus 5_pertussis, measles, chickenpox
what are the lab findings in leukemoid reaction
1_leukocytosis but not exceed 100k, blast<5%, toxic granulation, Doehle bodies 2_Anemia, plat N or H 3_BM WBC hyperplasia 4_ALP increase 5_Absent ph chromosome
what do you know about leukoerythroblastic reaction?
1_it’s the presence of immature myloid cells and NRBCs in the PB
2_caused by: secondary carcinoma of bone, MM, myelofibrosis, marble bone syndrome, lymphoma, thalessimia major, hemolytic anemia, Gauchers and Niemann. pick Ds.
3_in blood film; anisopoikilocytosis, tear drop, NRBCs 10%, reticulocytosis, WBC shift to the left, plat normal or reduced.
