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Pathology MBBS > Haematology > Flashcards

Haematology Flashcards

1
Q

Haemopoiesis sites

A

3rd week of intrauterine life- yolk sac
3rd month of intrauterine life- liver
4th month of intrauterine life- bone marrow and liver
Just before birth- bone marrow

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2
Q

CD marker to identify hematopoietic stem cell

A

CD-34

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3
Q

Myeloid series

A
  1. Myeloblast
  2. Promyelocyte: largest cell
  3. Myelocyte
  4. Metamyelocyte
  5. Band form
  6. Neutrophil
    Size 🔽 from promyelocyte to neutrophil
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4
Q

Leucopenia

Agranulocytosis

A 
🔽 in WBC county
Usually due to neutropenia
Cause:
1. Aplastic anemia
2. Drug toxicity
Agranulocytosis: clinically significant 🔽 in WBC count
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5
Q

Leucocytosis

A

🔼 WBC count

Reactive proliferation of WBC

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6
Q

Neutrophilia

A 
🔼 neutrophil count
Normal neutrophil count: 40-70%
Cause:
1. Acute infections
2. Tissue injury like MI, burns 
3. Bacterial infections
4. Myeloproliferative disorders
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7
Q

Eosinophilia

A 
Normal count: 1-6%
Causes:
1. Type 1 hypersensitivity like allergy
2. Parasitic/ helminthic infections
3. Tropical pulmonary eosinophilia
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8
Q

Basophilia

A 
Normal: 1%
Causes:
1. CML
2. Lymphocytosis
 • TB
 • viral infections
 • chronic infections
3. Lymphoproliferative disorders like CLL, ALL
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9
Q

Monocytosis

A 
Normal: 2-8%
Causes:
1. Malaria
2. Endocarditis
3. Rickettsiosis
4. Viral infections
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10
Q

Peripheral smear in sepsis or infection

A
  1. Toxic granule:
    Course & dark granule
  2. Dohle bodies:
    Patches of dilated endoplasmic reticulum
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11
Q

Neutrophil classification based on lobes

A 
1. Hypersegmented:
 >5 lobes seen
 In megaloblastic anemia due to vitamin B12 deficiency
2. Hyposegmented:
 <2 lobes seen 
Pseudo pelger huet cell
 In myelodysplastic syndrome
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12
Q

Morphological abnormalities in May Hegglin anomaly

A
  1. Giant platelets
  2. Low platelet count
  3. Inclusion within the cytoplasm
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13
Q

Abnormalities with granules in neutrophil

A

Chediak Higashi syndrome:
Dark purplish granule in giant granules in neutrophils
Alder Reilly abnormalities:
Most of the neutrophils have granules that obscure the nucleus

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14
Q

Classification of WBC neoplasms

A 
1. Lymphoid:
 ALL
 Chronic lympho proliferative disorders
2. Myeloid:
 AML
 Myeloproliferative disorders
 Myelodysplastic syndrome
 MDS/MPN
3. Dendritic cells:
 Langerhan’s histiocytes
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15
Q

Acute lymphoblastic leukemia

A

WHO definition:
>20% blasts in bone marrow and peripheral blood
Based on markers
FAB definition:
>30% blasts in bone marrow and peripheral blood
Based on morphology of blasts

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16
Q

Lymphoblast (🆚 myeloblast)

A 
Smaller
Scanty cytoplasm (🆚 moderate)
No granules
Auer rods absent
Course, clumped chromatin: most prominent
Inconspicuous nucleoli
Stain: PAS +ve
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17
Q

Myeloblast (🆚 lymphoblast)

A 
Larger size
Moderate cytoplasm
Granules present
Auer rods: hallmark
Open up/homogenous chromatin: most prominent
2-5 prominent nucleoli
Stain: MPO, Susan black B, NSE +ve
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18
Q

Acute lymphoblastic leukemia

ALL

A 
M/C cancer in children
Age: 2-9 years
Clinically:
1. Anemia ➡️ pallor, fatigue
2. 🔽 no of WBC - infections
3. 🔽 platelets - bleeding tendency
4. Hepatosplenomegaly due to extramedullary hematopoiesis 
5. Bone pain (eternal tenderness)
6. CNS involvement
7. Testicular involvement
8. Lymph node involvement
19
Q

FAB classification of ALL

A 
1. L1:
 Small homogenous blasts
 Scanty cytoplasm
 Inconspicuous nucleoli 
2. L2:
 Large, heterogenous
 Moderate cytoplasm
 Prominent nucleoli
3. L3:
 Large Burkitt’s ‘lymphoma-like’ blasts
 Vacuoles in blue 🔵 cytoplasm
20
Q

Differences b/w ALL types (FAB classification) based on their occurrence and prognosis

A 
L1:
 M/C
 Best prognosis 🍀ly
L3:
 Least common
 Worst prognosis
21
Q

WHO classification of ALL

A 
1. B-ALL: ☄️
 M/C with better prognosis  🍀ly
 Usually children
 No mediastinal invasion
 Loss of function mutation
 In PAX-5, E2A or EBF 🧬 
2. T-ALL:
 Adolescents 
 Mediastinal invasion can be present
 Gain of function mutation in NOTCH I 🧬 
 Poor prognosis
22
Q

ALL

Lab diagnosis

A 
1. CBC
 Hb and PLC 🔽
 TLC 🔽 or 🔼
2. Peripheral smear:
 >20% lymphoblasts
3. Bone marrow aspiration:
 >20% lymphoblasts 
In aleukemic leukemia:
 No blasts in peripheral smear but on bone marrow aspiration >20% blasts
23
Q

Stains for ALL

A
  1. PAS +ve called DOT/BLOCK positivity
    In AML-M6 shows diffuse PAS +ve
  2. T-ALL are acid phosphatase positive
24
Q

Markers of ALL

A
  1. Of both pre B and pre T lymphocytes: TdT+ Terminal deoxynucleotidyl transferase
  2. B-ALL: CD19, 10, PAX-5
  3. T-ALL: CD1, 2, 5, 7
  4. CD-10 called CALLA Common ALL Ag
25
Q

ALL

treatment

A
  1. Stem cell transplantation
  2. Chemotherapy: VAPD
    Vincristine
    L Asparaginase
    Prednisolone
    Doxorubicin
  3. Intrathecal methotrexate for CNS prophylaxis
26
Q

ALL prognostic factors

Good prognostic factors (🆚 bad = everything else)

A
  1. Age: 2-9 years
  2. Females
  3. Whites
  4. L1 subtypes
  5. B-ALL
  6. CNS, testis, spleen not involved
  7. Hyperdiploidy (>50 chr) 🆚 hypodiploidy
  8. Trisomy 4,7,10, t(12:21) 🆚 t(9:22)
  9. TLC < 1,00,000/ml
27
Q

AML

age and clinical presentation

A 
Age: 15-45 years
Clinically:
1. Non specific:
• Pallor, fatigue, 🔼 infections, bleeding tendencies, hepatosplenomegaly 
• Usually no CNS, testes or lymph node involvement
2. Specific:
• Gun hyperplasia/bleeding
• DIC
• Chloroma or granulocytic sarcoma
28
Q

AML

risk factors

A
  1. Chemicals and radiation ☢️
  2. Genetic syndromes:
    • Fanconi’s anemia
    • Bloom’s syndrome
    • Down’s syndrome
29
Q

AML

FAB classification

A 
AML M0 AML undifferentiated
M1 AML w/o maturation
M2 AML with maturation
M3 acute promyelocytic leukemia
M4 acute myelomonocytic leukemia
M5 acute monocytic leukemia
M6 acute erythro leukemia 
M7 acute megakaryoblastic leukemia
30
Q

Special features of some types of AML

A 
AML M0 is MPO -ve
AML M2:
• Pathogenesis t(8:21)
• M/C FAB type of AML
• Maximally associated with chloroma
AML M3: 
 Best prognosis
31
Q

Myeloblastoma
Chloroma
Granulocytic sarcoma

A 
Soft tissue involvement of AML
Comprised of myeloblasts and granulocytes
Green due to MPO +ve
M/C site: 👁 ➡️ proptosis 
Arbiskov cells:
 Presence of monocytes in a chloroma
32
Q

AML M3

Acute promyelocytic leukemia

A 
Associated with t(15:17):
 PML gene and RARA-α gene ➡️ 
AML RARA fusion protein ➡️ 
🔽 vitamin A level ➡️ 
🔽 conversion of promyelocytes-myelocyte ➡️ 
🔼 promyelocytes
33
Q

Characteristics of cells of promyelocytes

A
  • Have plenty of cytoplasmic granules and are usually hypergranular (azurophilic granules)
  • A hypogranular variant also exists
  • Few granules combine - Auer rods
  • Criss cross pattern of Auer rods: Faggot cells
  • Auer rods and faggot cells
34
Q

AML M3
complication
treatment

A

Complications:
Granules contain thrombotic material ➡️ breakage of granules causes its release ➡️ DIC
Treatment:
All trans retinoic acid ATRA + arsenic trioxide

35
Q

AML M4,5

A 
Stains:
• MPO +ve
• NSE +ve, a stain for monoblasts
Strongly associated with gum bleeding
AML M5 is M/C AML in infants 👶 
Associated with skin involvement:
 Leukemia cutis
36
Q

AML M6

A

Also called Di Gugleimo disease

Diffuse PAS +ve

37
Q

AML M7

A 
Secrete PDFG ➡️ myelofibrosis ➡️ dry tap on bone marrow aspirate
Associated with Down’s syndrome
CD 41+, CD 61+
Budding cytoplasmic margins can be seen
Least common type of AML
38
Q

WHO classification of AML

A 
1. AML with recurrent genetic abnormalities:
• t(8:21), t(25:17)
• inv 16 or t(16:16)
• t(11q:V)
• with normal cytogenetics and mutated NPM
2. AML therapy related: 🔽 prognosis
3. AML with MDS like features
4. AML not otherwise specified:
 all except AML M3
39
Q

WHO classification of AML with recurrent genetic abnormalities

A
  1. With t(8:21) RUN XI / ETO fusion gene: AML M2
  2. With t(15:17) PML / RARA fusion gene: AML M3
  3. AML with inv 6 out t(16:16) CBFB / MYHII fusion gene:
    AML M4 (eosinophilia)
  4. AML with t(11q:V) MLL fusion gene
  5. AML with normal cytogenetics and mutated NPM
40
Q

AML

lab diagnosis

A
  1. CBC:
    🔽 Hb, TLC, platelets
  2. Peripheral smear and bone marrow aspirate:
    • >20% myeloblasts
    • <20% with t(8:21), t(15:17) or inv. 16
  3. Stains
  4. Markers CD 13, 33, 117+, MPO +
41
Q

AML

stains

A
  1. MPO+ myeloperoxidase
  2. SBB+ Sudan black B
  3. NSE+ monoblasts
    AML M6 is diffuse PAS+
42
Q

AML

treatment

A
  1. Definitive Rx: stem cell transplantation

2. For AML M3 ATRA +Arsenic trioxide

43
Q

Biphenotypic leukemia

A

If blasts show both myeloid lineage markers as well as lymphoid markers, it is called biphenotypic
• Myeloid lineage markers: CD 13, 33, 117+, MPO+
• Lymphoid lineage markers: CD 19, 20, 10+, PAX 5+, CD 2, 3, 5, 7+

Pathology MBBS (17 decks)

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