Blood Lab 2

Question 1

Answer 1

normal BM aspirate smear

Question 2

67 yrs. old woman, presented with 2 months history of weakness, weight loss (20 Lbs ), fever, night sweats and “knots” in her neck.
Which ONE of the following will be most helpful in the diagnosis.
A-CT scan B-Chest X-ray C- Lymph node biopsy D- Bone marrow biopsy

Answer 2

C.

Should do bone marrow biopsy for staging, not a starting poiint for lymphoma.

Question 3

histological features of celiac disease

Answer 3

lymphocyte infiltration

villous blunting

Question 4

Answer 4

Hodgkins lupmhoma– there are reed sternberg cells

Question 5

Answer 5

reed-sternberg cells

Question 6

Q: Diagnosis and subtyping of Lymphoma require which of the following laboratory techniques
A-Tissue biopsy H&E & Immuno- peroxidase staining
B-Flow-cytometry
C-Molecular techniques like PCR and flourescent in-sity hybridisation (FISH).
D- All of the above

Answer 6

D

Question 7

What does the peripheral blood smear on this patient show?

Answer 7

rouleaux formation (hyper igG and IgM)– look for multiple myeloma

Question 8

which one is most likely to be multiple myeloma (you saw rouleaux on the PBS)

Answer 8

A= plasma cells

B= neutrphils– neutrophilia– reactive vs neoplastic (hematological malignancy due to myeloproliferative (CML, PV, ET , Primary myelofibrosis vs metastatic acute leukemia)

C= lymphocytes

D= more plasma cells

Question 9

multiple myeloma was confirmed on a patient wiht rouleaux. Serum protein electrophoresis was ordered. what do you expect to see on SPEP?

Answer 9

monoclonal banding– all th eB cells producing the same (but random and not functioning) immunoglobulin.

Question 10

62 year old man, presented with pancytopenia. what is the most concerning on the blood report?

Answer 10

presence of blasts. big red flag. acute leukemia until proven otherwise.

Question 11

Answer 11

B= it’s a blast. not a lymphocyte

Question 12

a person with this cell on the PBS most likely has:

Answer 12

AML– multiple auer rods.

Question 13

which bone marrow aspirate most likely represents a patient with AML?

Answer 13

B. more homogenous. tons of myeloid lineage progenitors. A has a bunch of different types of cells/

Question 14

What is the most likely diagnosis?

An 81 yrs. old woman presented with pallor & petechial hemorrhages and lymph node enlargement. Examine CBC repor

Answer 14

CLL– chronic lymphocyte leukemia. Lymphocytes are high and smudge cells are characteristic with CLL. Probably due to B cell hyperproliferation.

Question 15

what are smudge cells and whcih cell represents a smudge cell?

Answer 15

they are fragile degenerated CLL cells. A represents a smudge cell.

Question 16

after looking on the PBS and seeing smudge cells and a lot of lymphocytes, what is the next investigation that should be done to confirm CLL?

Answer 16

chronic lymphocytic leukemia

- flow cytometry (can see B vs T cell)

B cell function– immunoglobulin levels and vaccine titers

• bone marrow biopsy?

Question 17

Answer 17

C represents CLL.

• soccer ball cell lymphocytes
• smudge cells.

A is a normal blood smear

B= super huge cells. idk what this is. blasts? myeloid immature cells? acute leukemia

C= plasma cells. more likely to be hodgkins ( b cell with reed-sternberg cells) or DLBCL non-hodgkins.

Question 18

52 yrs. old man,, presented with pallor, weakness and bulge in left upper belly. Examine CBC report

what is the most likely diagnosis?

Answer 18

there is a really high platelet count and a high WBC count. Neutrophilia is present– could be reactive or neoplastic causes CML, PV, ET, Primary myelofibrosis, or acute leukemia.

blasts are present but the percentage is low compared to WBC. probably is not as acute as we think.

Not CLL because lymphocyte count is normal

chronic myeloid leukemia: neutrophila.

Question 20

what tests to run to confirm CML

Answer 20

PBS + CBC

FISH for philedelphia chromosome. (9;22)–> required for CML diagnosis

OR BCR-Abl1 detection PCR studies.

Question 21

which is most likely suggestive of chronic myeloid leukemia?

Answer 21

A= some degree of maturation, lots of stippling and basophils as well as banded neutrophils

B= normal. neutrphils, dividing cells, mixed and non-homogenous. normal bone marrow

C. lots of lymphocyte or blasts. most likely an acute leukemia because of immaturaty.

Question 22

42 yrs. old woman, with pallor, weakness and splenomegaly

what does this CBC data support?

Answer 22

• anemic
• low platelets: thrombocytopenic.

tear drop cells– trying to squeeze out of the bone marrow.

• myelocytes = immature myloid cells.

nucleated red cells. immature rbc.

supports bone marrow stress/bone marrow cancer, infiltrates, or a leuko-erythroblastic features

Question 23

what is a leukoerythroblatic picture

Answer 23

• increase in immature RBCs and WBC seen in differential and on blood film…caused by marrow infilitartion, severe marrow stress.

often due to cancer of the bone marrow.

Question 24

label the following cells

Answer 24

1. tear drop cells.
2. nucleated red cell
3. abnormal platelet
4. tear drop cell
5. blast or atypical lymphocyte
6. giant platelet.

Question 25

CBC data supportive of Leuko-erythroblastic picture can be seen in
A-Primary myelofibrosis

B-Metastatic carcinoma to BM

C-Significant BM fibrosis related to other causes

D-All of the above

Answer 25

leukoerthroblastic feature is immature RBC and WBC being seen in PBS due to bone marrow stress often cancer or fibrosis.

therefore, A, B, C. ALL OF THE ABOVE (D)