B3.041 Blood Cell Dyscrasias

Question 1

how might a lymph node feel if it is cancerous?

Answer 1

hard

fixed

Question 2

what would a tender lymph node signify?

Answer 2

inflammation

Question 3

at what lymphocyte count do you start to consider neoplasmic activity?

Answer 3

> 5000

too high for an acute issue

Question 4

why do platelets elevate in inflammation?

Answer 4

they are acute phase reactants

Question 5

discuss the steps in evaluating a potentially neoplastic lymph node

Answer 5

1. CBC w dif
2. blood smear
3. needle aspiration w/ flow cytometry
4. biopsy

Question 6

what is a normal differential count?

Answer 6

neutrophils- 50-60%
bands- 2-4%
lymphocytes- 30-40%
monocytes- 1-9%
basophils- 0-1%
eosinophils- 0-3%

Question 7

what are some non-neoplastic causes of neutrophilia?

Answer 7

increased granulopoiesis
-infections: primarily bacterial, immunological inflammatory, paraneoplastic, drugs
increased release from marrow stores
-endotoxemia, infection, hypoxia
decreased margination
-exercise, catecholamines

Question 8

what are some differences between follicular hyperplasia and follicular lymphoma?

Answer 8

hyperplasia:
preserved architecture
follicles/germinal centers
-low dens
-variable size
-polarized
-mitoses frequent
-tingible body macrophages present
-BCL2 NEGATIVE
distinct mantle zone
ample interfollicular tissue
lymphoma:
effaced architecture
follicles
-high density
-uniform or variable
-not polarized
-mitoses rare
-tingible body macrophages absent
-BCL2 POSITIVE
incomplete mantle zone
scant interfollicular tissue

Question 9

how to differentiate reactive neutrophilia from a myeloproliferative neoplasm

Answer 9

clinical scenario
morphological review (left shift, toxic granulation, Dohle bodies)
genetic tests (BCR/ABL1, JAK2, calreticulin)
bone marrow exam
flow cytometry not helpful bc these are identified by morphology

Question 10

how to differentiate reactive lymphocytosis from a lymphoproliferative neoplasm

Answer 10

clinical scenario
flow cytometry
genetic tests, based on flow cyt results
bone marrow or lymph node exam

Question 11

how to assess abnormal blasts

Answer 11

acute leukemia or other neoplastic process until proven otherwise
flow cytometry to assess blast lineage
bone marrow exam
genetic tests to assess subtypes and prognosis
morphological review- look for auer rods