Hematological Disorders: Lymphoma, Leukemia, Erythrocytosis

Question 1

Polycythemia Vera: __________ disorder; Excess production of ____________ (3), blood ________

Answer 1

Myeloproliferative (marrow); Erythroid, myeloid, and megakaryotic lines; Hyperviscosity

Question 2

Polycythemia Vera: History

Answer 2

-Asymptomatic/non-specific: Early on
-Erythromelalgia: Burning/redness to feet
-Headaches
-Blurred Vision
-Arterial/venous occlusive events (DVT)
-Pruritis
-Spontaneous bruising/bleeding
-Bone Pain (ribs and sternum)

Question 3

Polythycemia Vera: Physical Exam

Answer 3

-Bone Tenderness (Ribs and Sternum)
-Organomegaly (Liver + Spleen)
-Facial Plethora (Redness)
-Skin excoriations with significant pruritis
-Gouty tophi/arthritis
-Hypertension

Question 4

Polythycemia Vera: Lab Findings

Answer 4

-CBC: Erythrocytosis (RBC count, Hb, Hct), thrombocytosis (>400,000), leukocytosis
-Chem Panel-Hyperuricemia, elevated LDH (enzyme found in RBCs), Hypercholesterolemia
-Special Tests: EPO decreased

Question 5

Causes of Secondary Erythrocytosis

Answer 5

Causes: High altitude, chronic lung disease, congenital heart disease, smoking (any prolonged CO exposure, renal tumor, testosterone administration

Question 6

Lab Findings: Secondary Erythrocytosis

Answer 6

CBC
-Erythrocytosis
-NL WBCs
-NL Platelets
Special Tests
-EPO: Increased

Question 7

Causes of Relative Erythrocytosis

Answer 7

-Dehydration: Vomiting & diarrhea, severe burns, lack of water intake
-Asking history questions-

Question 8

Lab Results: Relative Erythrocytosis

Answer 8

CBC
-Erythrocytosis
-NL: WBCs/Plts
Special Tests
-EPO: Normal

Question 9

Leukemia vs. Lymphoma

Answer 9

-Leukemia: Hyperproliferation in bone marrow
-Lymphoma: Lymph nodes, MALT, spleen, bone marrow, thymus

Question 10

Hodgkins Lymphoma: Characteristics

Answer 10

-Local spread to nearby lymph nodes
-Reed Sternberg cell
-Bimodal age distribution: 20s-30s and 55+ are the most common age cohorts

-Management: Referral (Tissue biopsy of lymph node

Question 11

Hodgkins Lymphoma: Clinical Findings

Answer 11

-Localized, progressive, painless lymphadenopathy
-Frequency of lymph node involvement: Cervical>mediastinal>axillary>para-aortic
-Unilateral involvement of lymph nodes
-Sx: Night Sweats, night pain, weight loss, anorexia, pruritis (early)
-Pel-Ebstein Fever: 3-10 days of fever>no fever>have fever again
-Alcohol induced pain: Pain immediately after drinking alcohol
-Marrow involvement that can lead to pain

Question 12

Hodgkins Lymphoma: Lab Findings

Answer 12

-RBCs, Hb, HCt: May or may not see anemia
-WBCs: Lymphocytopenia, Neutrophilia/ eosinophillia possible
-ESR indicates active disease

Question 13

Non-Hodgkin’s Lymphoma

Answer 13

-Distant spread: Spreads more
-More likely to convert to leukemia

Question 14

Lymph node classifications

Answer 14

-Painless = malignancy/Pain =infection)
-Consistency: Metastasis (Hard), Rubbery (Hodgkin), Soft (Infection)

Question 15

ALL: Clinical Findings

Answer 15

-Pediatric population (Around 4 yoa-peak age)
-Lung Symptoms (Wheezing, stridor, SOB)
-CNS Findings
-Headaches, vomitting, lethargy
-Testicular enlargement
-Lymphadenopathy
-night sweats, weakness, weight loss
*Any of the leukemia symptoms

Question 16

ALL: Lab Findings

Answer 16

-Leukocytosis (15,000-50,000)
-Anemia
-Thrombocytopenia
-Characteristic Cell: Lymphoblasts (>25%); 90% lymphocytes

Question 17

AML: Clinical Findings

Answer 17

-Proliferation and accumulation of immature myeloid blast
-Adults >70

Question 18

AML: Lab Findings

Answer 18

Leukocytosis
Anemia
Thrombocytopenia
-Characteristic Cell: Myeloblast

Question 19

CLL: Clinical Findings

Answer 19

-Accumulation of mature but non-functional lymphocytes
-MC chronic leukemia in adults in the US
-70+ years
-Chronic fatigue, lymphadenopathy

Question 20

CLL: Lab Findings

Answer 20

-Leukocytosis, Lymphocytosis, anemia, thrombocytopenia
-Characteristic cells: Smudge cell, absoulte monotonous lymphocytosis
-Chem panel: Hypogammaglobulinemia

Question 21

CML: Clinical Findings

Answer 21

-Proliferation of myeloid precursors in bone marrow w/ continuing differentiation into mature granulocytes
-3 clinical phases: Chronic (85-90%), Accelerated, Blast/crisis
-Insidious onset of nonspecific symptoms: Fatigue, weakness, anorexia, weight loss, fever, night sweats, or abdominal fullness (Splenomegaly)
-Predominant age: 50-60

Question 22

CML: Lab Findings

Answer 22

-Marked Leukocytosis: 200,000-1,000,000
-Anemia
-Thrombocytosis: Eosinophilia + Basophilia
-Characteristic Cell: Band Neutrophils, myelocytes, prometemyocytes, myeloblasts
-Special tests: Philadelphia Chromosome