clinpath 2: polycythemia and lymphoproliferative disorders Flashcards
what is polycythemia?
increased PCV. A better term would have been erythrocytosis.
relative polycythemia
hemoconcentration: It looks like its increased, but really the fluids is decreased. Dehydration is the most common causeFluid shifts (this can happen fairly suickly eg. Colitis)RedistributionExcitement and exercise (splenic contration)
absolute polycythemia
increased Epo that is either appropriate or inappropriate
appropriate increase
Chronic hypoxia, lung disease, heart disease
inappropriate
EPO secretion renal cysts, tumors (this one is not very common)- fooling the cells into thinking that they are hypoxic.
primary polycythmia
is a myeloproliferative disorder where all cell lines are affected
what is leukemia
presence of neoplastic cells in peripheral blood and/or bone marrow or spleen.
aleukemic leukemia
no white cells
subleukemic leukemia
normal white cells
leukemic leukemia
drastically high white cells
what is the difference bt acute and chronic leukemia
acute tends to have a lower degree of maturation, and therefore the prognosis is very poor with survival times being low (20% more more blast cells in the marrow) chronic leukemia tends to be characterized by mature white cells and the survival time is longer
lymphoproliferative disorders are
lymphocytes and plasma cells
myeloproliferative disorders
are cells of the bone marrow stem cells: neutrophils, erythrocytes, rarely eosinophils and basophils
> 35000 is>15000 and erlichia negative
is leukemia!!!!!!
acute lymphoblastic leukemia (ALL)
Differentiate from stage V lymphomaLots of dogs presenting with multicentric lymphoma are leukemia50% of dogs with ALL will have lymphadenopathy
CBC associated with acute lymphoblastic leukemia
- Thrombocytopenia - Lymphocytosis (usually) - lymphoblasts in the bloodPrognosis is poor, course is rapid and progressive and respond poorly to therapyCats are usually younger and FeLV positive.
Chronic lymphocytic leukemia
Cells are small and appear well differentiatedMost common in dogs, but can be in other species. Way more common in dogs than cats. Differentiate from other causes of lymphocytosisIf >35,000 its leukemia, but it can be lower and still be leukemia
two ddxs for chronic lymphocytic leukemia
stress/ excitement in cats; cat scratch fever
clinical signs of chronic lymphocytic leukemia
can either be asymptomatic, ill, lethargic, anorexia, pale mucosal membranes, lymphadenopathy, splenomegaly, hepatomegaly
lab findings chronic lymphocytic leukemia
Lymphocytosis(slightly greater to above 300,000Maybe anemia, thrombocytopeniaIncreased small lymphs in the bone marrowRarely monoclonal gammopathyCats are usually Fe-LV negative
CD 8
T cell
CD21
Bcell
CD 4-8-5
abberant T cells
CD34+
proginator cells
Multiple myeloma
Proliferation of plasma cells at various sites of the bone marrow and eventually other tissuesRelease into the peripheral blood happens, but its in small numbers. If a leukemia is lumped on, then survival time is very lowOn the left you see flame cells, they have an eccentric nucleus, and the immunoglobulin is not released. This accounts for the pink color
also a monoclonal gammopathy
signs of multiple myeloma
Depends on where the neoplastic plasma cells are.Also related to the immunoglobulins produced which result in hyperviscosisty of the blood. This can manifest as neurological signs. Also depends on the Ig. IgG there is not as much viscosity as IgM.
you seeMore than 20% plasma cells in the bone marrow, but this can also happen in antigenic stimulation, so you should differentiate from this.Monoclonal or biclonal gammopathy (igG and IgA) and this is referred to as a paraproteinBence jones proteins in the urine (the remanants of the light chains when Igs break up). These proteins cannot be picked up by dip sticks. Maybe send in fpr protein electrophoresis.Light chain disease (when the cells just produce the light chains). When this happens, you can miss a multiple myeloma because everything is going into the urine.Thrombocytopenia ( and the platelets will also fail to work), maybe. Depends on what is happeneing in the bone marrow
multiple myeloma
what is polycythemia?
increased PCV. A better term would have been erythrocytosis.
relative polycythemia
hemoconcentration: It looks like its increased, but really the fluids is increased. Dehydration is the most common causeFluid shifts (this can happen fairly suickly eg. Colitis)RedistributionExcitement and exercise (splenic contration)
absolute polycythemia
increased Epo that is either appropriate or inappropriate
appropriate increase
Chronic hypoxia, lung disease, heart disease
inappropriate
EPO secretion renal cysts, tumors (this one is not very common)- fooling the cells into thinking that they are hypoxic.
primary polycythmia
is a myeloproliferative disorder where all cell lines are affective
what is leukemia
presence of neoplastic cells in peripheral blood and/or bone marrow or spleen.
aleukemic leukemia
no white cells
subleukemic leukemia
normal white cells
leukemic leukemia
drastically high white cells
what is the difference bt acute and chronic leukemia
acute tends to have a lower degree of maturation, and therefore the prognosis is very poor with survival times being low (20% more more blast cells in the marrow) chronic leukemia tends to be characterized by mature white cells and the survival time is longer
lymphoproliferative disorders are
lymphocytes and plasma cells
myeloproliferative disorders
are cells of the bone marrow stem cells: neutrophils, erythrocytes, rarely eosinophils and basophils
> 35000 is>15000 and erlichia negative
is leukemia!!!!!!
acute lymphoblastic leukemia (ALL)
Differentiate from stage V lymphomaLots of dogs presenting with multicentric lymphoma are leukemia50% of dogs with ALL will have lymphadenopathy
CBC associated with acute lymphoblastic leukemia
- Thrombocytopenia - Lymphocytosis (usually) - lymphoblasts in the bloodPrognosis is poor, course is rapid and progressive and respond poorly to therapyCats are usually younger and FeLV positive.
Chronic lymphocytic leukemia
Cells are small and appear well differentiatedMost common in dogs, but can be in other species. Way more common in dogs than cats. Differentiate from other causes of lymphocytosisIf >35,000 its leukemia, but it can be lower and still be leukemia
two ddxs for chronic lymphocytic leukemia
stress in catscat scratch fever
clinical signs of chronic lymphocytic leukemia
can either be asymptomatic, ill, lethargic, anorexia, pale mucosal membranes, lymphadenopathy, splenomegaly, hepatomegaly
lab findings chronic lymphocytic leukemia
Lymphocytosis(slightly greater to above 300,000Maybe anemia, thrombocytopeniaIncreased small lymphs in the bone marrowRarely monoclonal gammopathyCats are usually Fe-LV negative
CD 8
T cell
CD21
Bcell
CD 4-8-5
abberant T cells
CD34+
proginator cells
Multiple myeloma
Proliferation of plasma cells at various sites of the bone marrow and eventually other tissuesRelease into the peripheral blood happens, but its in small numbers. If a leukemia is lumped on, then survival time is very lowOn the left you see flame cells, they have an eccentric nucleus, and the immunoglobulin is not released. This accounts for the pink color
signs of multiple myeloma
Depends on where the neoplastic plasma cells are.Also related to the immunoglobulins produced which result in hyperviscosisty of the blood. This can manifest as neurological signs. Also depends on the Ig. IgG there is not as much viscosity as IgM.
you seeMore than 20% plasma cells in the bone marrow, but this can also happen in antigenic stimulation, so you should differentiate from this.Monoclonal or biclonal gammopathy (igG and IgA) and this is referred to as a paraproteinBence jones proteins in the urine (the remanants of the light chains when Igs break up). These proteins cannot be picked up by dip sticks. Maybe send in fpr protein electrophoresis.Light chain disease (when the cells just produce the light chains). When this happens, you can miss a multiple myeloma because everything is going into the urine.Thrombocytopenia ( and the platelets will also fail to work), maybe. Depends on what is happeneing in the bone marrow
multiple myeloma
what is polycythemia?
increased PCV. A better term would have been erythrocytosis.
relative polycythemia
hemoconcentration: It looks like its increased, but really the fluids is increased. Dehydration is the most common causeFluid shifts (this can happen fairly suickly eg. Colitis)RedistributionExcitement and exercise (splenic contration)
absolute polycythemia
increased Epo that is either appropriate or inappropriate
appropriate increase
Chronic hypoxia, lung disease, heart disease
inappropriate
EPO secretion renal cysts, tumors (this one is not very common)- fooling the cells into thinking that they are hypoxic.
primary polycythmia
is a myeloproliferative disorder where all cell lines are affective
what is leukemia
presence of neoplastic cells in peripheral blood and/or bone marrow or spleen.
aleukemic leukemia
no white cells
subleukemic leukemia
normal white cells
leukemic leukemia
drastically high white cells
what is the difference bt acute and chronic leukemia
acute tends to have a lower degree of maturation, and therefore the prognosis is very poor with survival times being low (20% more more blast cells in the marrow) chronic leukemia tends to be characterized by mature white cells and the survival time is longer
lymphoproliferative disorders are
lymphocytes and plasma cells
myeloproliferative disorders
are cells of the bone marrow stem cells: neutrophils, erythrocytes, rarely eosinophils and basophils
> 35000 is>15000 and erlichia negative
is leukemia!!!!!!
acute lymphoblastic leukemia (ALL)
Differentiate from stage V lymphomaLots of dogs presenting with multicentric lymphoma are leukemia50% of dogs with ALL will have lymphadenopathy
CBC associated with acute lymphoblastic leukemia
- Thrombocytopenia - Lymphocytosis (usually) - lymphoblasts in the bloodPrognosis is poor, course is rapid and progressive and respond poorly to therapyCats are usually younger and FeLV positive.
Chronic lymphocytic leukemia
Cells are small and appear well differentiatedMost common in dogs, but can be in other species. Way more common in dogs than cats. Differentiate from other causes of lymphocytosisIf >35,000 its leukemia, but it can be lower and still be leukemia
two ddxs for chronic lymphocytic leukemia
stress in catscat scratch fever
clinical signs of chronic lymphocytic leukemia
can either be asymptomatic, ill, lethargic, anorexia, pale mucosal membranes, lymphadenopathy, splenomegaly, hepatomegaly
lab findings chronic lymphocytic leukemia
Lymphocytosis(slightly greater to above 300,000Maybe anemia, thrombocytopeniaIncreased small lymphs in the bone marrowRarely monoclonal gammopathyCats are usually Fe-LV negative
CD 8
T cell
CD21
Bcell
CD 4-8-5
abberant T cells
CD34+
proginator cells
Multiple myeloma
Proliferation of plasma cells at various sites of the bone marrow and eventually other tissuesRelease into the peripheral blood happens, but its in small numbers. If a leukemia is lumped on, then survival time is very lowOn the left you see flame cells, they have an eccentric nucleus, and the immunoglobulin is not released. This accounts for the pink color
signs of multiple myeloma
Depends on where the neoplastic plasma cells are.Also related to the immunoglobulins produced which result in hyperviscosisty of the blood. This can manifest as neurological signs. Also depends on the Ig. IgG there is not as much viscosity as IgM.
you seeMore than 20% plasma cells in the bone marrow, but this can also happen in antigenic stimulation, so you should differentiate from this.Monoclonal or biclonal gammopathy (igG and IgA) and this is referred to as a paraproteinBence jones proteins in the urine (the remanants of the light chains when Igs break up). These proteins cannot be picked up by dip sticks. Maybe send in fpr protein electrophoresis.Light chain disease (when the cells just produce the light chains). When this happens, you can miss a multiple myeloma because everything is going into the urine.Thrombocytopenia ( and the platelets will also fail to work), maybe. Depends on what is happeneing in the bone marrow
multiple myeloma
are lytic lesions of the bone probable with multiple myeloma
yes, they are. look for aspects like cord compression
impaired platelet function is something else you may see with multiple myeloma
Yes
signs of multple myeloma are
lethargy, anorexia, lameness, bleeding from the nares, PU/PD
fundoscopic changes
kidney: impaired tubular and glomerular function from excess protein;mineralization of kidneys secondary to hypercalcemia
neurological signs secondary to viscous blood
25% of dogs may have a bleeding disorder
signs in cats of multiple myeloma
atypical plasma cell morphology
anemia
bone lesions
organ involvement
definitions of myeloid neoplasms
lack of normal cell in the blood or the presence of neoplastic cels at the lvl of the bone marrow (dysplasia)
T/F myelodysplastic syndromes and myeloproliferative neoplasms are both gradual in progression
true
acute myeloid leukemias are rapid in progression
True
myelodysplasic syndromes lab signs
RBCs and RBC precursors are abnormal is size leading to macrocytosis and anisocytosis
dudsynchrony of nuclear and cytoplasmic maturation
cytopenia in a singla or all lines
animals will be sick and have a bad prognosis
T/F myelodysplastic syndromes are usually not preleukemic
False, they ARE preleukemic….usually
to define an acute myloid leukemia, ___% or greater blast cells in the bone marrow must be present
20%
is it possible for mylouid leukemia cells to be present in the peripheral blood
yes it is
T/F undifferentiated leukemias have the most underdeveloped cells and cannot be classified
what species are undifferentiated leukemias present in
True
cats
ultrastructural cytochemistry or immunochemistry can be used to classify ______
undifferentiated leukemia
on bone marrow aspirate, if you see more than 90% blasts with less than 10% undifferentiated. What might you be looking at, but you can tell that they are granulocytic
myeloblastic leukemia
20% blasts but 10% differentiated granulocytes
Often may promyelocytes
myeloblastic leukemia with differentiation
True/ False. Immune mediated neutropenia can appear similar to granulocytic leukemia
False
T/F. Myelomonocytic leukemia:
Myeloblasts and monoblasts are >20% in the BM
True
Monocytic leukemmia (M5)
M5a Promonocytes and monoblasts >80% of non erythroid cells
M5b >20% to < 80% promonocytes and monoblasts
erythroid leukemia
Erythroid >50%, myelobalsts and monoblasts and <20%
M6ER if most blasts are erythroid, called erythremic myelosis
megakaryoblastic leukemia
> 20% megakaryoblasts and increased in the blood
is it possible to see megakaryoblastic leukemia can include____ and ____
thrombocytopenia and thrombocytosis
neutropenia?
T/F. Chronic granulocytic leukemia is more common in dogs than in cats
True
maifests as a marked neutrophilia, left shift and often a monocytosis. You see hypersegmented nuclei and giant metamyelocytes, and bands
chronic granulocytic leukemia
DDxs for chronic granulocytic leukemias
MDS, but CGL has marked leukocytosis
inflammatory or leukemoid reactions
eosinophilc leukemia is rare, but when it is seen, it is usually in ___ with___
cats; FeLV
DDx for eosinophilic leukemia
hypereosinophilic syndrome
