Chapter 6 Flashcards
How to treat neutropenia due to drug toxicity?
Give G-CSF or GM-CSF….
What is the most sensitive/earliest change to emerge after whole body radiation?
Lymphopenia (decreased number of lymphocytes)
In response to bacterial infection, see neutrophilic leukocytosis. What characterizes the immature cells (band cells)
Decreased Fc receptors (CD16). Don’t function quite as well…
During Hodgkin lymphomas, often see eosinophilia. What drives this?
Eosinophilic Chemotactic factor (Il-5).
When do you see basophilia?
CML
With what bacterial infection do you classically see LYMPHOCYTIC leukocytosis and why?
Bordetella pertussis. Produces lymphocytosis-promoting factor, which blocks circulating lymphocytes from leaving blood…
During infectious mononucleosis, what part of the lymph node expands to cause lymphadenopathy and with what cell type?
The paracortex expands, filled with CD8+ T cells…
During infectious mononucleosis, what part of the spleen expands leading to splenomegaly?
The Peri-Articular Lymphatic Sheath (PALS), also filled with CD8+ T cells…
What do you see in the WBC during infectious mononucleosis?
Incerased WBC with atypical lymphocytes (reactive CD8+ T cells)
If a patient has all of the symptoms of mono but a negative monospot test, what do they have?
CMV
Major complication of infectious mononucleosis?
SPLENIC RUPTURE!
What staining do you see with B-ALL?
TdT + (lymphoblastic) AND CD10, CD19, or CD20
What is TdT staining?
Stains for a DNA polymerase found in the nucleus of lymphoblasts…
Cytogenic abnormality seen in B-ALL commonly found in children?
t(12;21). Good prognosis
Cytogenic abnormality seen in B-ALL commonly found in adults?
t(9;22). Philadelphia. Worse prognosis…
What staining do you see with T-ALL?
TdT+ and CD2-CD8
Down syndrome is linked with leukemias. Which two do you frequently see and at what age?
Acute Megakaryoblastic Leukemia 5 yo.
What staining do you see with AML?
Myeloperoxidase + and Auer Rods (crystal aggregates of MPO)
Acute promyelocytic leukemia is due to what cytogenic abnormality, causes what complications, and can be treated how?
t(15;17), translocation of RAR on 17 to 15. This allows them to dimerize, inhibits signally, blocks maturation…
Causes DIC!!!
Treat with all-trans-retinoic acid!
Symptoms of Acute monocytic leukemia?
Infiltrate gums, cause inflammation and bleeding.
What markers are expressed on CLL?
CD5 and CD20. Neoplastic proliferation of naive B cells, but CD5 (normally on T cells) erroneously expressed…
What markers are expressed on Hairy Cell Leukemia and it is a cancer of what type of cell?
Neoplastic proliferation of mature B cells with hairy cytoplasmic processes. Positive for TRAP
Clinical features of hairy cell leukemia?
- Splenomegaly (due to accumulation of hairy cells in RED PULP)
- Marrow fibrosis
- Lymphadenopathy normally absent.
How to treat Hairy Cell Leukemia?
Cladribine (2-CDA), an adenosine deaminase inhibitor. Get excellent results.
What is mycosis fungoides?
Neoplastic proliferation of mature CD4+ T cells that infiltrate the skin!
What are Pautrier microabscesses and when do you see them?
Aggregates of neoplastic T cells in the epidermis. Seen in Mycosis Fungoides.
When Mycosis Fungoides cells spread to the blood, what is it called?
Sezary Syndrome
What mutation causes polycythemia vera?
JAK2 Kinase mutation
What are the clinical symptoms associated with polycythemia vera?
- Blurry vision/headaches
- Increased risk of venous thrombosis (think BUDD-CHIARI SYNDROME!)
- Flushed face due to congestion
- Itching, esp. after bathing. Due to histamine release from increased numbers of mast cells.
What EPO and SaO2 levels are seen in Polycythemia vera?
SaO2 normal and EPO decreased
What EPO and SaO2 levels are seen in Reactive Polycythemia? (hint- 2 types)
- Due to high alt/lung disease, see inc. EPO and low SaO2
2. Due to ectopic EPO production (renal cell carcinoma) see normal SaO2 and increased EPO.
Cause of Essential Thrombocythemia?
JAK2 Kinase mutation.
Symptoms of Essential Thrombocythemia?
Bleeding/Thrombosis. Rarely progresses to marrow fibrosis/acute leukemia, and no sign. risk of hyperuricemia/gout.
Cause of Myelofibrosis?
JAK2 Kinase mutation…
What cell markers are expressed in follicular lymphoma and what translocation causes it?
Express CD20 (B cells!). Caused by t(14;18) moving the Bcl2 gene on 18 next to IgG heavy chain.
What translocation causes mantle cell lymphoma?
t(11;14), moving Cyclin D1 next to IgG heavy chain. Cyclin D1 promotes G1/S transition.
When do you frequently see Marginal Zone Lymphomas?
When marginal zones are present, ie. during chronic inflammation.
Specifically, Hashimoto thyroiditis, Sjogren syndrome, and H pylori gastritis (MALToma)
Where does Burkitt Lymphoma arise in African vs. sporadic cases?
African –> jaw
Sporadic –> abdomen
What causes Burkitt’s Lymphoma?
t(8;14), which moves c-Myc (oncogene) next to IgG heavy chain.
What cell markers are found on Hodgkin Lymphoma Reed-Sternberg cells?
CD15 and CD30 (NOT CD20, even though B cell origin)
In the mixed cellularity subtype of Hodgkin’s Lymphoma, how are eosinophils drawn in?
Due to Il-5 production…
What cytokine is often present in Multiple Myeloma to drive the plasma cell growth?
Il-6
When are Birbeck granules (tennis rackets) and CD1a+ and S100+ cells seen?
Langerhans Cell Histiocytosis
