DDX Blood Cancers Flashcards
Polycythemia Vera would have which CBC findings?
Erythrocytosis, leukocytosis, thrombocytosis, with decreased EPO
Secondary Erythrocytosis has what EPO change?
Increased EPO
A Dx of Polycythemia Vera requires what next step?
Hematologist referral for bone marrow biopsy
A chem panel for polycythemia Vera would show?
Hyperuricemia, elevated LDH, and hypercholestremia
A patient presents with a history of gout and hypertension. Patient complains of significant pruritis. Physical exam shows splenomegaly. CBC leukocytosis, thrombocytosis and erythrocytosis. Dx?
Polycythemia Vera
Marked leukocytosis and thrombocytosis are hallmarks for which leukemia?
CML
Smudge cells and monotonous cells are characteristic of?
CLL
Leukocytosis, thrombocytopenia and anemia are all present in which leukemias
ALL, AML, CLL
Lymphocytosis is present in which 2 leukemias?
ALL, CLL
Most common leukemia adults?
CLL
What is the characteristic cell of AML?
Myeoblasts with auer rods
A Pel-Ebstein fever is characteristic of?
Hodgkin lymphoma
Which lymphoma is more likely to have distant spread and is also likely to convert to leukemia?
Non-Hodgkin
Which leukemia often converts to lymphoma?
CLL
Patient has lymph node px after drinking, most likely condition?
Hodgkins Lymphoma
What is the characteristic cell of Hodgkins Lymphoma
Reen Sternberg cells
What is the age distribution for Hodgkin lymphoma?
Bimodal
2 Peaks: 20-30 and 55+
T or F
Hodgkins lymphoma is painful.
False
Painless which increases malignancy risk
Frequency of lymph node involvement for lymphoma?
MC= Cervical
Then mediastinal, axillary, para-aortic
And usually unilateral
Alcohol induced pain is characteristic of…?
Hodgkin lymphoma
What is Pel-Ebstien fever and what is it characteristic of?
increased fever for 3-10 days with no known origin, then no fever for a few days, then repeats.
Hodgkin lymphoma
If you see this on a CBC what is the most likely Dx?
-May or may not have anemia
-Neutrophilia with leukocytosis
-Lymphocytopenia
-Eosinophilia
-increased ESR
Active Hodgkin lymphoma
What is the diagnostic triad for Hodgkins lymphoma
- Pel-Ebstein fever
- Pruitis
- Lymphadenopathy
Follow up managment for Hodgkins lymphoma?
Lymph node biopsy
What linage of cells are effected by Acute and Chronic forms of leukemia?
Acute- Blast cells
Chronic- Resemble WBC “cytes” but not mature
What cells are effected by Myeloid or Lymphoid leukemia?
Myeloid- Monocytes, basophils, eosinophils, and neutrophils
Lymphoid- B & T cells
Why do you typically see anemia and thrombocytopenia with leukemia?
Increase in WBC production in bone marrow takes up space and nutrients, causing a decrease in RBC and platelet production.
What additional tests can be done when suspecting leukemia?
comprehensive blood panel- will show increased LDH and increased uric acid
ESR- will see a noticeable increase
Managment for leukemia?
Referral to hematologist or oncologist
Bone marrow biopsy
What is the number one childhood cancer?
ALL Acute lymphoblastic leukemia
CBC shows:
Leukocytosis (15K-50K)
Anemia
Thrombocytopenia
Lymphoblasts (can be up to 25%)
What is the most likely Dx?
ALL
What is the most common adult cancer?
CLL Chronic Lymphoblastic Leukemia
CBC shows:
Leukocytosis
Lymphocytosis (monotonous in shape)
Anemia
Thrombocytopenia
Smudge cells
What is the most likely Dx?
CLL
What would a chem panel show for CLL?
Hypogammaglobulinemia
If you have a patient over the age of 50, chronic fatigue with no known cause, lymphadenopathy and splenomegaly, CBC shows Lymphocytes over 50%, WBC over 15,000
What is the most likely Dx?
CLL
What is the SECOND most common adult cancer?
AML Acute Myeloid Leukemia
CBC shows:
Leukocytosis
Anemia
Thrombocytopenia
Myeloblast
What is the most likely Dx?
AML
What type of leukemia has 3 clinical phases? And what phase are you most likely going to see in your office?
CML Chronic Myelogenous Leukemia
Chronic phase. 85-90% of patients present in chronic phase and found accidentally during routine screenings.
SSx; Insidious onset of nonspecific symptoms like fatigue, weakness, anorexia, weight loss, fever, night sweats, or abdominal fullness.
CBC shows:
Leukocytosis (very high 200K-1Million)
Anemia
Thrombocytosis
Possible Eosinophilia
Possible Basophilia
Myeloid cells in variable stages of development
CML
Philadelphia chromosome abnormality is a special test for what cancer?
CML
Pruitis can be found in what conditions/illness?
Lymphoma and Polycythemia vera
CBC shows:
Erythrocytosis
Leukocytosis
Thrombocytosis (high potentially over 400K)
And decreased EPO
What is the most likely Dx?
Polycythemia Vera
CBC shows:
Erythrocytosis
WBC and platelets WNL
EPO increased
What is the most likely Dx?
Secondary Erythrocytosis
CBC shows:
Erythrocytosis
WBC and platelets WNL
EPO WNL
What is the most likely Dx?
Relative Erythrocytosis
What are some things that can cause Secondary Erythrocytosis?
Hypoxia (COPD, Emphysema, smoker, higher altitude, congestive heart failure)
Renal tumor
Testosterone injections
Dehydration causes what type of Erythrocytosis?
Relative Erythrocytosis
Gouty tophi or arthritis can be caused by what disorder and why?
Polycythemia Vera
Because of increased RBC, as they break down the nuclei break down to give biproduct of uric acid.
On a Chem panel you see:
Hyperuricemia
Elevated LDH
Hypercholesterolemia
and EPO is decreased
What is the most likely Dx?
Polycythemia vera
What is the management for Polycythemia Vera?
Hematologist for bone marrow biopsy.
Then when confirmed phlebotomy, myelosuppressive therapy, maintain hydration, uric acid reducing therapy, diet avoiding iron supplements or organ meat.
Normal range for RBC?
Women 3.5-5.5 Mil/microL
Men 4.3-5.9 Mil/microL
What is the normal hemoglobin ranges?
Women 14 g/dL +/- 2 (<11= anemia)
Men 16 g/dL +/- 2 (<13= anemia)
What is the normal hematocrit range?
Women 37-47%
Men 40-54%
Normal range for MCV?
80-100 FL
Anisocytosis is difference in size of RBC.
<80 MCV=?
>160 MCV=?
<80= microcytosis
>160= macrocytosis
What is the normal RDW (variability in RBC)?
11-15%
What is the normal WBC count range?
4,500-11,000 /mL
Normal ranges for:
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
N= 50-70%
L= 20-40%
M= 2-10%
E= 1-5%
B= 0-1%
What is the normal range for platelets?
150,000-400,000 / microL
What is the range of platelets you would expect to see clinically evident bleeding like easily bruising or hemorrhage?
<70,000 / microL