HEMA 2 (Intro) Flashcards
A disease, usually of leukocytes in the blood and bone marrow
LEUKEMIA
Requests to rule out leukemia
PBS, Bone Marrow Aspiration
Leukemia symptoms of short duration; patient last only 2-6 months
ACUTE LEUKEMIA
Leukemia with many immature cell forms in the bone marrow and/or peripheral
blood
ACUTE LEUKEMIA
Total leukocyte count of acute leukemia
elevated
Leukemia with symptoms of long duration; patient lasts 1-2 years
CHRONIC LEUKEMIA
General term for malignancy that starts on lymphatic system →
mainly the “lymph nodes” (solid tumor)
LYMPHOMA
Total leukocyte count in chronic leukemia
extremely elevated to lower than normal
Solid tumors: accumulation of malignant cells present in lymph nodes
LYMPHOMA
TWO TYPES OF LYMPHOMA
HODGKIN LYMPHOMA
NON-HODGKIN LYMPHOMA
Proliferation of malignant cells of the lymphocytes, which have basophilic vacuolated cytoplasm with “starry sky pattern” due to numerous tangible body macrophage that are arrested at certain stages of maturation
HODGKIN LYMPHOMA
Hallmark: presence of Reed-Sternberg Cell
HODGKIN LYMPHOMA
large binucleated/multinucleated cell resembles appearance with each nucleus bearing a very large nucleolus
Reed-Sternberg Cell
Diffuse large B cell lymphoma
NON-HODGKIN LYMPHOMA
mixed population of lymphocyte histiocytes, eosinophils, and some plasma cells
NON-HODGKIN LYMPHOMA
form of cancer (CA) of the plasma cells in the bone marrow
MYELOMA
Overproduction of various types of immature or mature leukocytes in the bone marrow and/or
peripheral blood
LEUKEMIA
Presence of Bence Jones proteins containing light-chains in the urine
MYELOMA
Solid malignant tumors of the lymph nodes
LYMPHOMA
PLASMA CELL CHARACTERISTICS
Cartwheel cytoplasm
Basophilic cytoplasm (Increased RNA)
Eccentric nucleus
Hoff near the nucleus
Malignant cells freely trespass the BBB
LEUKEMIA
Overproduction of plasma cells in the bone
marrow with concurrent production of abnormal proteins
MYELOMA
Malignant cells of lymphoma are initially confined in these organs containing mononuclear phagocytic cells
Lymph nodes
spleen
liver
BM
Mimics lab result of leukemia
LEUKOMOID REACTION
response or reaction to
infection or malignancy
LEUKOMOID REACTION
Plasma cells form mass/tumor in BM
Myeloma
WBC count of LEUKOMOID REACTION
High (>500,000)
LAP in LEUKOMOID REACTION
Increased
Shift in LEUKOMOID REACTION
Left shift
Present in LEUKOMOID REACTION
Dohle bodies
TG
Absent in LEUKOMOID REACTION
Auer rods
Philadelphia chromosomes
WBC count in CHRONIC MYELOGENOUS LEUKEMIA
High (malignant cells)
LAP in CHRONIC MYELOGENOUS LEUKEMIA
Decreased
Shift in CHRONIC MYELOGENOUS LEUKEMIA
Left shift
Similarities of leukomoid reaction and leukemia
o Excessive leukocytosis
o Immature cells (blasts, promyelocytes, myelocytes) in PB
Present in CHRONIC MYELOGENOUS LEUKEMIA
Auer bodies
Philadelphia chromosomes
language of medicine
Classification
essential for both clinical practice and investigation
consensus or definitions and terminology
3 IMPORTANT COMPONENTS TO THE PROCESS OF DEVELOPING
CLASSIFICATION OF HEMATOLOGIC MALIGNANCIES
1st: Since underlying cause of neoplasm are often unknown, we use: clin. features, morph, immunophenotype, genetic
2nd: as many experts as possible
3rd: pathologists - primary classification (w/ clinicians involvement)
According to this, there is no one “Gold Standard” by which all diseases are defined
WHO
Included in French-American-British (FAB) Classification
Cellular Morphology
Cytochemistry
Patient history
Included in WHO classification
FAB criteria + Immunophenotyping and Molecular Technology – Cytogenetics
(chromosome translocations, dysplasia)
Leukemia classification based on clonal proliferation
lymphoid or myeloid
Clonal proliferations of malignant leukocytes that
arise initially in the bone marrow before disseminating to the peripheral blood, lymph nodes, and other organs
LEUKEMIA
Leukemia classification based on clinical course
acute or chronic
First to recognize leukemia as a distinct clinical
disorder between 1839 and 1845.
He named this disorder leukemia because of the
white appearance of the blood from patients with
fever, weakness, and lymphadenopathy
Virchow
Predominant symptoms in CHRONIC LEUKEMIA
Enlargement of liver, spleen and lymph nodes
Common symptoms in ACUTE LEUKEMIA in presence of large leukemic cell mass
Bone pain
clonal disease that develops subsequent to the malignant transformation of one or more normal hematopoietic progenitor cells
Leukemia
FACTORS RELATED TO THE OCCURRENCE OF LEUKEMIA
1) Genetic and immunological factors
2) Occupational exposure
3) Environmental exposure
4) Chemical and drug exposure
5) Genetic abnormalities and associations
6) Viral agents
7) Secondary causes
Mutations in a ___ gene are found in many cases of leukemia;
Larger changes in ______ are also common
Single
One or more chromosomes
occupational factor associated with an increased incidence of leukemia
Ionizing radiation
Central regulators of growth in normal cells
Have rare involvement in cancer (consequence of somatic mutations)
PROTOONCOGENES
Conditions most frequently associated with radiation
Acute and chronic forms of myelogenous leukemia (AML/CML)
Condition associated with exposure to high levels of radiation
Acute leukemia
most common human aneuploidy
Down Syndrome (Trisomy 21)
Common chemical that may cause AML if prolonged exposure
Benzene
First recognized link between a specific virus and a human malignant disease
DNA-related EBV with Burkitt’s lymphoma
Chemical exposure is more strongly linked to an increased risk of this condition
Acute myelogenous leukemia (AML)
Leukemia associated to children with down syndrome
ALL
Acute Megakaryoblastic Leukemia (AMKL)
Blood condition associated to newborns with down syndrome
Transient Myeloproliferative Disorder (TMD), a preleukemic form of AMKL
Secondary AML may develop in patients with
hematologic disorder (e.g., severe congenital neutropenia)
inherited disease (e.g., Fanconi’s anemia)
MDS (3 months)
first retrovirus to be isolated from patients suffering from aggressive T-cell cancers with skin involvement
HTLV-I
first RNA tumor virus (retrovirus) known to occur in humans
HTLV
Leukemia classification based on Natural History
Acute, Subacute, Chronic
refractory “no” to remission (state of a patient where no signs and symptoms are seen), usually fatal within 3 months
Acute Leukemia
BM packed primitive cells
20% of BM cells are blasts
Acute Leukemia
have longer patient survival of 3-12 months
usually have a clinical picture of an acute leukemia
Subacute Leukemia
having a survival of >1 year if no current remission occurs
blasts are elevated (↑) in BM and blood
Chronic Leukemia
FAB
More uncommon forms of leukocytic leukemia are:
✓ Acute undifferentiated (stem cell)
✓ Eosinophilic
✓ Basophilic
Leukemia accdg. to Functional Capacity of Release Mechanism
Leukemic, Subleukemic, Aleukemic
with NO immature cells (since they remain in the BM) in the blood with WBC count <15,000/uL
Aleukemic Leukemia
presence of immature or abnormal cells in blood with WBC counts >15,000/uL
Leukemic Leukemia
4th edition (2008) of the WHO classification stratifies neoplasms primarily according to lineage:
Myeloid lymphoid
Histiocytic/dendritic cell
buffy coat smear can be used to examine this type of leukemia
Aleukemic Leukemia
with immature or abnormal cells in the blood with WBC count <15,000/uL
Subleukemic Leukemia
Leukemia with WBC count >15,000/uL
Leukemic Leukemia
Leukemia with WBC count <15,000/uL
Subleukemic, Aleukemic
FAB Separated into three broad leukocytes groups:
1) Myelogenous
2) Monocytic
3) Lymphocytic
FAB
Major types of leukocytic leukemias can be classified as acute or chronic according to the leukocyte groups:
✓ Acute or Chronic Myelogenous
✓ Acute or Chronic Monocytic
✓ Acute or Chronic Myelomonocytic
✓ Acute or chronic Lymphocytic Leukemia (CLL)
Classification is based on morphology but combine this information with Immunophenotyping and Genetic Studies
World Health Organization (WHO) Classification
