Exam 2 -- Hematology #2 Flashcards
What two types of leukocytes make up the majority of WBCs? Which WBCs are least abundant?
Neutrophils and lymphocytes (B cells, T cells, and NK cells) make up about 90% of WBCs; basophils make up only 0.5%.
How long do WBCs live for?
3-4 days
Neutrophils are also known as polymorphic leukocytes (PMNs). What is their function?
Ingest and kill bacteria and damaged cells
What are a couple of causes of neutrophilia?
Smoking*, inflammation (gout, RA)
What are a couple of causes of neutropenia?
Chemotherapy, radiation; nutritional deficiency
B cells, T cells, and NK cells make up the lymphocytes. What is their function?
They respond to viral and bacterial infections; B cells create antibodies.
What is a common cause of lymphocytosis?
Smoking*
Monocytes, if found in the tissue, are called macrophages. What is their function?
They engulf and kill bacteria, create pro-inflammatory response to the infection, and clear cellular debris.
What is the function of eosinophils and basophils?
They release histamine, cytokines, heparin, and prostaglandins as part of allergic and infectious response.
What is a common cause of eosinophilia?
Parasitic infections
True or false: all hematologic malignancies are more common in Caucasians
False; leukemias and lymphomas are more common in Caucasians, multiple myeloma is more common in African Americans
Leukemia is an overprodution of either immature “blast” cells or mature WBCs. This overproduction can suppress production of _________________ and _________________
RBCs (Anemia) and platelets (thrombocytopenia) – these two are specifically low in AML (part of testing)
What are some of the signs and symptoms of leukemia?
Fatigue, fever, retinal hemorrhages, CWS, anemia, thrombocytopenia, abdominal discomfort (splendomegaly), weight loss, night sweats, headaches, recurrent infections, lymphadenopathy, bone pain
In terms of leukemia, what does the term “acute” mean?
It means that the symptoms occur relatively suddenly; it also refers to “blast” cells (immature) cells being involved. Generally, acute forms of leukemia are more common in children.
In terms of leukemia, what does the term “chronic” mean?
It means that the symptoms last over a longer period of time; it also refers to mature cells being involved. Generally, chronic forms of leukemia are more common in adults.
In AML, what are the myeloid precurors unable to do?
Mature, leading to accumulation of those immature forms.
What is the median age of onset for AML?
65 years
Which gender has a higher prevalence for AML? What factors are associated with its development?
Male; development is thought to be associated with chemical exposure and genetics
A CBC count would show what in a patient with AML?
High WBC, low RBC and low platelets
A blood smear in a patient with AML would show what?
Increased myeloblasts and Auer rods
What is the remission rate for AML?
40% of patients under 60 experience remission, but prognosis is worse for elderly males
How would you treat AML?
Chemotherapy, radiation, stem cell replacement, leukapheresis, hydration, antibiotics
What is the most common form of leukemia in children?
ALL; it accounts for 1/3 of all childhood cancers
The Philadelphia chromosome is a modified form of chromosome 22. What types of leukemia is the Philadelphia chromosome associated with?
CML (97% of CML patients); ALL (30-40% of ALL patients)
Which gender and age group has a higher prevalence for ALL?
Males 2-5 years
What sort of testing can be done for ALL?
CBC (looking for increased lymphoblasts); genetic testing
How would you treat ALL?
Chemotherapy, radiation, stem cell replacement, leukapheresis, hydration, antibiotics; neutropenic diet; tyrosine kinase inhibitors for patients with Philadelphia chromosome (helps decrease lymphoblast production)
How does the remission rate for ALL in children compare to that in adults?
Complete remission occurs in 80% of children but only 25-30% of adults
CML is characterized by uncontrolled production of mature WBCs. What percentage of adult leukemias are CML?
About 15%
What is the peak onset age of CML?
50-60 years
What genetic abnormality is seen in most patients with CML?
Philadelphia chromosome
What is a blast crisis in CML?
It’s when blast cells can start showing up and causing problems. It occurs in a patient with CML if they go untreated for a long time. You’d want to treat a blast crisis as if this were an acute leukemia.
What testing can be done for CML?
CBC looking for elevated WBC, and genetic testing for Philadelphia chromosome
What are the treatment options for CML?
Tyrosine kinase inhibitors (Imatinib) results in a 95% response rate, chemotherapy, stem cell transplant
What is the 5-year survival rate for CML?
90%
True or false: CLL is the least common adult form of leukemia.
False; it is the most common adult form of leukemia, making up 1/3 of adult leukemias
What is the median age of onset for CLL?
70 years
What percentage of CLL arises from B cell proliferation?
95%
Which gender is more affected by CLL?
Males
What testing can be done for CLL?
CBC looking for elevated lymphocytes; blood smear (showing no blasts with normal-looking lymphocytes
What are the treatment options for CLL?
Chemotherapy (Chlorambucil), stem cell transplant, radiation
Although some patients with CLL die within 2-3 years, what is the median survival rate?
10 years
Lymphomas are the ___________ most common malignancy in the Western world
5th
True or false: lymphoma is the most common form of blood cancer
True.
The lymphatic system is composed of what structures?
Lymph nodes, bone marrow, thymus, spleen, tonsils, GI tract
The lymphatic system consists of B cells and T cells. What is the function of this system?
Fight infection, remove fluid from tissue
Hodgkin’s lymphoma is slightly more common in _________________ (males/females)
Males
Hodgkin’s lymphoma is associated with what virus?
Epstein-Barr Virus
What is the peak age of onset for Hodgkin’s lymphoma?
It shows a bimodal distribution – about age 20 and age 65
What are some of the symptoms that a patient with Hodgkin’s lymphoma might present with?
Painless enlargement of a lymph node, fever, night sweats, weight loss, pruritus (itching)
What are some tests that can be done for Hodgkin’s lymphoma?
Lymph node biopsy showing Reed-Sternberg cells (“owl eyes”), PET scan, chest X-ray
How would you treat Hodgkin’s lymphoma?
Chemotherapy and radiation
What is the prognosis for a treated patient with Hodgkin’s lymphoma?
About 80% cured
Which is more common, Hodgkin’s or non-Hodgkin’s lymphoma?
Non-Hodgkin’s lymphoma
True or false: non-Hodgkin’s lymphoma has the same symptoms as Hodgkin’s lymphoma but can also progress to involve the CNS
True.
True or false: non-Hodgkin’s lymphoma does not metastasize
False; it can metastasize
The testing and treatment for non-Hodgkin’s lymphoma is the same as for Hodgkin’s lymphoma, with one exception. What is that exception?
Lymph node biopsy in non-Hodgkin’s lymphoma would not show Reed-Sternberg cells (no “owl eyes”)
True or false: most patients with non-Hodgkin’s lymphoma survive 6-10 years from diagnosis
True.
Burkitt’s lymphoma is a subtype of non-Hodgkin’s lymphoma and is the fastest growing human tumor. It is the most rapidly prolierating type of lymphoma, involving what type of lymphocyte?
B cells
Which gender is more commonly affected by Burkitt’s lymphoma?
Male
True or false: Burkitt’s lymphoma is associated with Epstein-Barr Virus
True.
What is a typical presentation of a patient with Burkitt’s lymphoma?
Jaw or belly tumor, in a child
Multiple myeloma is characterized by overproduction of what type of cells?
Plasma cells from bone marrow (secrete IgG, IgA, sometimes IgM)
True or false: the median age of onset for multiple myeloma is below 50
False; it is over 60 years
Which gender and ethnic group have a higher prevalence for multiple myeloma?
Males; African Americans
True or false: multiple myeloma is the most common hematologic malignancy.
False; it is the second most common hematologic malignancy
What are some of the signs and symptoms of multiple myeloma?
Bone pain (70%), spinal cord compression, increase in osteoclasts, hypercalcemia, real failure, anemia (73%), neutropenia, thrombocytopenia, recurrent infections
What testing can be done for multiple myeloma?
Urine testing (looking for increased protein), X-ray (looking for decreased bone mass and “peper pot” defects in skull), bone marrow biopsy
Though multiple myeloma is not curable, there are a few treatment options. What are they?
Chemotherapy, radiation therapy, bisphosphonates, stem cell transplant
How long might you expect an individual with multiple myeloma to live, if they are treated?
5 years
