(F) L2.1 : LAP and acute myeloid leukemia Flashcards
a disease of leukocytes in the blood and bone marrow; uncontrolled proliferation of a clone of malignant WBCs
Leukemia
solid tumor neoplasms of lymphoid tissues
lymphoma
2 main types of lymphoma
- Hodgkin
- Non-hodgkin
form of cancer of the plasma cells
myeloma
non malignant tumors are caused by
congenital genetic abnormalities
General characteristics of hematologic neoplasm
(acquired / congenital) genetic disease
acquired
patient acquires the disease sometime in life due to consistent genetic
Non-malignant yung congenital
General characteristics of hematologic neoplasm
type of infection as well as the treatment
Systemic infection, therefore treatment MUST also be systemic
ex; chemotherapy, radiation, supportive therapy, targeted therapies, hem
General characteristics of hematologic neoplasm
of unkown cause
idiopathic
except environmental factors like radiation and chemical exposure
Agents / Factors affecting occurence of leukemias and lymphomas
Matching type
a. Genetic and immunological factors
b. Genetic abnormalities and association
c. Viral agents
____1. Down syndrome, Fanconi anemia
____2. Translocation B and A interchange
____3. Age
____4. Mutations in a single gene
____5. Epstein B
ABAAC
Agents / Factors affecting occurence of leukemias and lymphomas
types of exposure that can become factors in the occurence of leukemias and lymphomas (3)
environmental, chemical, and drug exposure
- known as reactive neutrophilia
- inflammatory reaction which frequently resembles leukemia on bone marrow or blood smears
leukemoid reaction
all but one is a characteristic of leukemoid reaction
* WBC count is elevated (>50,000 / mK)
* Presence of severe infection or inflammation
* Involves lymphocytes with some immature forms
* Increased leukocyte alkaline phosphatase (LAP) index
Involves neutrophils with some immature forms
leukemoid reaction vs chronic myeloid leukemia
- normal count and morphology for eosinophils and basophils
- toxic granulation and Dohle bodies are often found in neutrophil morphology
- Normal platelet count and morphology
- Normal hemoglobin
- Elevated LAP score
- Normal genetics
Leukemoid reaction
Leukemoid reaction vs Chronic Myeloid Leukemia
- Often elevated eosinophils and basophils with possible mixed granulation
- pseudo-Pelger-Huet forms in Neutrophil morphology
- Platelet count is elevated in early detection, decreased in late
- anemic hemoglobin
- decreased LAP score
- Positive for t(9;22); BCR-ABL [genetics]
chronic myeloid leukemia
Leukemoid reaction vs Chronic Myeloid Leukemia
which one has a genetic abberation (presence of Philadelphia chromosome)
Chronic myeloid leukemia
LAP matching type:
a. naphthol AS-MX
b. blue pigment (insoluble)
c. violet pigment (insoluble)
____1. Naphtol AS-MX phosphate - alkaline phosphatase
____2. Naphthol AS-MX + fast violet B salt
____3. Naphthol AS-MX + fast blue RR salt
ACB
LAP
How many neutrophils and bands must be examined before giving a rating of - to 4+
100 neutrophils and bands
LAP matching type
refreence range:
a. 12-180
b. 32-182
c. 15-170
____1. Fast Blue RR
____2. Rodak’s
____3. Fast violet B
BCA
LAP matching type
a. 0-13
b. more than 100
____1. Leukemoid reaction
____2. Chronic myelogenous Leukemia
____3. Leukemia
____4. Polycytemia vera
BAAB
LAP cytochemical stain scoring
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
- none (%), no granules, no staining
- 80-100%, medium to large granules, strong staining
- 50-80%, small granules, moderate to strong staining
- 50% small granules, faint to moderate staining
- 100%, medium to large granules, brilliant staining
ADCBE
LAP
staining used in LAP
cytochemical stains
LAP
How to compute for the lap score?
(cells counted) (rating)
repeat that for all ratings and all of their products
CML has a (increased/decreased) LAP score
explain why :>
increased
(despite having a lot of cells, they’re dysfuctional, = no acid phosphatase activity)
2 categories leukemia is differentiated
a. clinical course of the disease
b. cell type
types of leukemia
what are the two clinical courses of leukemia?
acute and chronic
types of leukemia matching type
a. chronic
b. acute
- sudden onset, rapid progression, and fatal outcome of weeks to months if left untreated
- insidious onset with gradual and slow progression, reslting to longer survival even if left untreated
BA
types of leukemia
what are the four major categories of chronic leukemia
a. Acute myeloid leukemia (AML)
b. Acute lymphoblastic leukemia (ALL)
c. Chronic myeloid leukemia / chronic myelogenous leukemia
d. Chronic lymphocytic leukemia (CLL)
what are the types of leukemia categorized by cell type
myeloid and lymphoid
leukemia and lymphoma classification
a. French American British (FAB) classification
b. WHO classification
- more complicated
- based on molecular, morphologic, and clinical features
- based on morphology and cytochemistry
- Mostly based on how the leukemia cells will look under the microscope after routine staining
- Some of the elements from FAB were retained but gives emphasis on the molecular and cytogenetic changes involved in the type of leukemia
BBAAB
acute myeloid leukemia
- most common in (adults / children)
- rare in adolescents, common in (blank)
- bone and joint pain are present in (25%/85%) of cases
- (hepatomegaly / splenomegaly)
- (common / rare) CSF involvement
- adult
- adolescents, children under 1 yr old
- 25%
- splenomegaly
- rare