AML (Exam III)

Question 1

acute

Answer 1

rapidly progressive disease characterized by an abnormal expansion of immautre cells or blasts

Question 2

myeloid

Answer 2

includes cell lines that divide in BM
- granulocytic
- Erythrocytic
- megakaryocytic
- monocytic

Question 3

leukemia definition

Answer 3

malignant disease of hematopoietic tissue that is characterized by replacement of normal BM elements with abnormal (neoplastic) blood cells

Question 4

AML other names

Answer 4

Acute Myeloid Leukemia

Question 5

AML classifications

Answer 5

FAB:
- >30% blasts in blood or BM
- cytochemistry
- microscopic morphology

WHO:
- >20% blasts in blood or BM

Question 6

AML NOS classifications

Answer 6

M0-M7

Question 7

M0

Answer 7

Myeloid with minimal differentiation

Question 8

M1

Answer 8

myeloid without maturation

Question 9

M2

Answer 9

Myeloid with maturation

Question 10

M4

Answer 10

myelomonocytic

Question 11

M5

Answer 11

M5a - monocytic, poorly differentiated
M5b - monoctytic, well differentiated

Question 12

M6

Answer 12

Pure erythroid leukemia

Question 13

M7

Answer 13

megakaryoblastic

Question 14

NOS AML other types

Answer 14

Basophilic
Panmyelosis with myelofibrosis

Question 15

M0 AML

Answer 15

Myeloid With Minimal Differentiation

Morphologically undifferentiated blasts with myeloid immunophenotype
- no further maturation
- no distinctive myeloid morpholohical features
- no cytochemical maturation. Cytochemical stain: Negative

Question 16

Immunophenotype M0

Answer 16

CD34
CD38
HLA-DR (hematopoietic precursor)

Negative cell markers for lymphoid antigens: CD3, CD79a, CD22

Question 17

M1 AML

Answer 17

primarily myeloblasts
- no further maturation stages
- possible auer rods

Cytochemical stain
MPO +
SBB +
SE +

Question 18

Immunophenotype M1 AML

Answer 18

CD13 (myeloid)
CD33 (myeloid)
CD34
CD117

Question 19

myeloperoxidase stain (MPO)

Answer 19

Positive stain: bluish-black granules

AML: (+)
- myeloblastic
- myelomonocytic
ALL: (-)

Question 20

SBB (sudan Black B Stain)

Answer 20

Stains phospholipids
positive - brownish-black granules
- present in granulocyte and weakly in monocyte lysosomal granules

Cell structures stained bt SBB are “sudanophilic”

AML +
ALL -

Question 21

Specific esterase (SE) - Napthol-AS-D Chloroacetate Esterase (CAE)

Answer 21

Stains “specific esterase” in primary granules of myeloid cells
- positive staining: bright red granules
- Present in neutrophils, basophils, mast cells and their precursors

AML+
ALL -

Question 22

M2 - AML

Answer 22

Leukemia cells show prominent maturation beyond myeloblast stage
- >20 % myeloblasts
- >10% promyelocyte or more mature

Auer Rods present

MPO+, SBB+, SE+

Question 23

M2 AML Immunophenotype

Answer 23

C11b,CD13,CD15,CD33,CD34

Question 24

M4 - AMML

Answer 24

Leukemic cell mixture: myelocytic and monocytic

Monoblasts, promonocytes, monocytes are increased >5x10-^9/L

MPO+, SBB+, SE+, NSE+

Muramidase (anit-microbial enzyme in monocytic line)
- increased serum and urine muramidase

Question 25

M4 - AMML Immunophenotype

Answer 25

CD13, CD15, CD33, CD65

and

one or more monocytic antigen (CD4, Cd11b< yes it can be both myeloid/monocytic, CD11c, CD14, CD36, CD64, CD68, CD163. or lysosome).

Question 26

Non Specific Esterase

Alpha-Naphthyl Butyrate (specific)

alpha=naphthyl acetate (sensitive)

Answer 26

Stains “non-specific esterase” activity in monocytic cell
- positive staining - brick red stain
- both - stains strongly posiitve in monocytic cell line
- Acetate - positive in megakaryocytes, and lightly in T cell lymphocytes

Can repeat the stain with sodium fluoride, which would inhibit monocytic cell line staining

AML (monocytic line) +
ALL (granulocytic line) -

Question 27

Combined esterase

Answer 27

stains both “specific esterase” and “non-specific esterase”
- positive staining
1. specific - blue
2. non specific - red/brown

+ for both - acute myelomonocytic leukemia
+ for non-specific only - acute monocytic leukemia

useful when smears are limited.