Bikman - Leukemia Flashcards
Neutrophils: What is their purpose, where are they found?
- Fight infection and participate in inflammatory processes
- Most neutrophils reside and mature in bone marrow
- 5% found in blood, most are segmented
What are the two types of neutrophilia? Which type is the most predominate? Where does this type predominate?
Mature
- Highly segmented
- Predominates in blood
Immature
- Not segmented
What are the causes of mature neutrophilia?
Highly segmented
Causes:
- Infection (bacterial)
- Inflammation
- Stress
What is leukocytosis?
A WBC count above the normal range
What are some benign leukocytoses?
- Neutrophilia
- Lymphocytosis
- Basophilia
- Monocytosis
- Eosinophilia
What is a unique histological characteristic of neutrophilia?
Band cells
What are toxic changes that are observed with mature neutrophilia?
Seen only with infection
- Toxic granulation
- Dohle bodies
- Cytoplasmic vacuolization
Cells are becoming less differentiated, nucleus is becoming less segmented.
What are Dohle bodies? Which benign leukocytoses would you observe this phenomenon in?
Light blue-gray, oval, basophilic, leukocyte inclusions located in the peripheral cytoplasm of neutrophils.
What are the causes of immature neutrophilia?
- Infection (bacterial)
- Inflammation
- Severe anemia
- Marrow displacement
What conditions is bone marrow displacement observed in?
- Immature neutrophilia
- Myelophthisic anemia
What are the three forms of immature neutrophilia?
- Left shift
- Leukemoid reaction
- Leukoerythroblastotic reaction
What is left shift immature neutrophilia?
Neutrophils are becoming less differentiated
What is the leukemoid reaction in immature neutrophilia?
The natural elevation in leukocytes in response to stress or infection
What is the leukoerythroblastotic reaction in immature neutrophilia?
- Same as leukemoid, but with nucleated RBCs
- Indicates severe disruption of bone marrow
- May indicate malignancy
What are lymphocytes and what are the different types (%’s of types)?
- Fight infection and participate in immune responses
- T-cells: 80%
- B-cells: 15%
- NK cells: 5%
What are the two types of lymphocytosis?
Mature
- Lots of normal cells
Reactive
- Lots of ABnormal cells
What are the causes of mature lymphocytosis?
- Infectious lymphocytosis
- Bordetella pertussis
- Transient stress
Which benign leukocytoses can be caused by Bordetella pertussis?
Mature lymphocytosis
What are the causes of reactive lymphocytosis?
- Infectious mononucleosis
- Pediatric viral infectioons
- Viral hepatitis
- Immune disorders
What are Downey cells and in which benign leukocytosis is this condition observed in?
Abnormal segmentation of lymphocytes.
Found in reactive lymphocytosis
How common is basophilia? Which leukemia is it a component of?
Uncommon
A component of chronic myelogenous leukemia
What are the causes of monocytosis?
- Infection
- Autoimmune disease
- Malignancy
What are the causes of eosinophilia?
- Drugs
- Asthma
- Skin diseases
- Parasites
Eosinophils are characteristically found in which of the following conditions?
A. Bacterial infections
B. Viral infections
C. Fungal infections
D. Parasitic infections
D. Parasitic infections
What is the difference between leukemia and lymphoma?
Leukemia
- Starts in the bone marrow, can spread to blood, nodes
- Myeloid or lymphoid
- Acute or chronic
Lymphoma
- Starts in lymph nodes, can spread to blood, marrow
- ONLY lymphoid
- Hodgkin or non-Hodgkin
What is immunophenotyping?
A technique used to study the protein expressed by cells
What is cytogenetics?
A branch of genetics that is concerned with the study of the structure and function of the cell, especially the chromosomes
What are the 4 different types of leukemia?
- Acute Myeloid (AML)
- Chronic Myeloid (CML)
- Acute Lymphoblastic (ALL)
- Chronic Lymphoblastic (CLL)
What is used to diagnose leukemia?
- Clinical setting
- Morphology
- Immunophenotyping
- Molecular studies
- Cytogenetics
What are characteristics of acute leukemias?
- Sudden onset
- Occurs in children and adults (usually >60)
- Rapidly fatal without tx
- Composed of immature cells (blasts)
What are characteristics of chronic leukemias?
- Slow onset
- Occurs only in adults
- Longer course
- Composed of mature cells
What is acute leukemia?
Malignant proliferation of immature myeloid or lymphoid cells in the bone marrow
What are the causes of acute leukemia?
- Clonal expansion
- Maturation failure
What are the symptoms of acute leukemia?
- Fatigue
- Infections
- Bleeding
- Bone pain
- Lymphadenopathy
What is the lethality of acute leukemias due to?
- Inhibition of normal cell function
- Infiltration of organs
Compromised immune system is usually what kills them
What are some histological differences between AML and ALL?
AML
- Loss of segmentation
ALL
- No more cytosol
What can be observed in lab results for AML and ALL?
- Blasts in the blood
- Leukocytosis
- Anemia (blood cells produced are not working well)
- Thrombocytopenia (bleeding disorders)
Marked hyperplasia and loss of hematopoietic elements (the glassy substance is overtaking)
What is Acute Myeloid Leukemia (AML)? Are there many subtypes and what is the prognosis?
Does AML typically occur in adults or children?
The malignant proliferation of myeloid blasts (>20%) in blood and bone marrow
- Many subtypes
- Poor prognosis
- Mostly occurs in adults
What are Auer rods? In what leukemia would we observe this phenomenon?
Auer rods: Clumps of granules that form elongated needles that jet out from the nucleus in the cytoplasm of leukemic blasts
What are current treatments for AML?
- Chemotherapy
- Bone marrow transplant
What is myelodysplastic syndrome?
- Poorly understood myeloid tumors that can spread to blood and become AML
- Characterized by disordered hematopoiesis
- Can lead to macrocytic anemia
- Progresses to AML in 10-40% of cases
How does myelodysplastic syndrome manifest?
Changes in blood cell production
What is Acute Lymphoblastic Leukemia (ALL)?
The malignant proliferation of lymphoid blasts in blood and bone marrrow
What are the features of ALL?
- Most common in children
- Good prognosis
- – Immunophenotype (T is BAD; better to catch it early)
- – WBC count (<10K is good)
- – Cytogenetics (polyploidy is good, more responsive to chemotherapy)
- Classified by immunophenotype (B vs. T)
What are the different lymphocyte lineages in ALL and what is the prognosis for each?
T-lineage ALL
- Bad prognosis
B-lineage ALL
- B-ell PRECURSOR ALL: Better prognosis
- B-cell ALL: Bad prognosis
- *STARRY SKY PATTERN**
In what leukemia is the starry sky pattern observed histologically?
B-lineage ALL
What are current treatments for ALL?
- Chemotherapy
- Bone marrow transplant
What is chronic leukemia?
The malignant proliferation of mature myeloid or lymphoid cells in the bone marrow.
*Because these are mature cells, they are harder to work with
What is the big difference between chronic and acute leukemia?
Cancer cells are mature in chronic leukemias, making them harder to work with
What are symptoms of chronic leukemia?
- Weight loss
- Fatigue
- Infections
- Bone pain
- Similar to acute, but more gradual
What are the causes of chronic leukemia
- Clonal expansion (mature cells)
- Functional failure
What is the lethality of chronic leukemias due to?
- Inhibition of normal cell function
- Infiltration of organs
*They look like mature cells but they don’t act like it
What are some histological differences between CML and CLL?
CML
- Less segmentation
CLL
- Too much segmentation
- Nuclear alterations
What are some characteristics of CML?
- Occurs only in adults (~60yo)
- Long course (takes awhile before it’s lethal)
- Increase WBC with left shift
- Hypercellular bone marrow
- Splenomegaly
What are the four different manifestations of CML?
- CML
- Chronic myelofibrosis
- Polycythemia vera
- Essential thrombocythemia
What are some characteristics of CML?
- Neutrophilic leukocytosis
- Basophilia
- Philadelphia chromosome
- Three phases
What is the Philadelphia chromosome? In which leukemia is it found?
Translocation of chromosomes 9 and 22.
CML
What are the three phases of CML?
- Chronic phase
- Acte phase
- Blast crisis
What are features of the chronic phase in CML?
- Stable counts
- Easily controlled
- 3-4 years (without therapy)
What are features of the acute phase in CML?
- Unstable counts
- Fatal within months
What are features of blast crisis in CML?
- Lots of blasts
- Fatal within weeks
What are treatments used in CML?
USED to be bone marrow transplant, but
NOW, we use Imatinib (Gleevec) which is a tyrosine kinase inhibitor
What is the prognosis for CML?
The median used to be 5-6 years but may be longer now with new treatment
Which leukemia is treated with imatinib (Gleevec)?
CML
What are some features of Chronic Myelofibrosis?
- Panmyelosis (a form of myeloid metaplasia)
- Advancing to marrow fibrosis
- Extramedullary hematopoiesis
- Teardrop red cells
What are some features of Polycythemia Vera?
- High hematocrit (RBC count) because of increased EPO
- Can cause hypertension (because the blood is thicker)
What is an issue that might arise when trying to diagnose Polycythemia Vera?
In order to conclude that it is cancer, you must distinguish it from secondary PV
How can secondary PV arise?
By kidneys being “tricked” into thinking that there’s blood loss = MORE EPO
» Ex: Blocked renal artery
What are features of Essential Thrombocythemia?
- High platelet count
What is an issue that might arise when trying to diagnose Essential Thrombocythemia?
Must also distinguish from secondary ET to conclude it’s cancer.
How can secondary ET arise?
Too many platelets.
Some platelet or clotting disorders, chronic bleeding that produce more platelets
What is CLL?
The malignant proliferation of lymphocytes
What are some features of CLL?
- Most common of all leukemias
- Occurs only in adults
- Many disorders; CLL is predominant
- Long course
- Indolent but mostly incurable
Indolent = causing little or no pain
What are some histological features of CLL?
- Small, mature lymphocytes
- B cells, but CD5+
- Smudge/smear cells - broken cells
- Cannot produce antibodies
In which leukemia type would you see smudged/smeared cells? Which leukemia are B cells not able to produce antibodies?
CLL
What are some treatments for CLL?
It’s incurable.
Treatment usually includes treating infections
What is the prognosis for CLL?
- WBC counts to monitor
- 9 years
Usually die of infection
No definite causes have been ID for leukemia.
Possible risk factors include genetic predisposition, environmental exposure to chemicals and radiation, and viruses.
A. Both statements are true.
B. Both statements are false.
C. First is true, second is false.
D. First is false, second is true.
A. Both statements are true.
The Philadelphia chromosome and low levels of leukocyte alkaline phosphatase are common characteristics of which type of leukemia?
CML
The primary organ(s) involved in acute leukemia is/are the:
Bone marrow
Acute lymphoblastic leukemia equally affects young children and adults.
The acute leukemia is the most responsive to treatment.
A. Both statements are true.
B. Both statements are false.
C. First is true, second is false.
D. First is false, second is true.
D. First is false, second is true.
