Hematology & Oncology Flashcards
Pathological Blood Films
Target Cells
Tear Drop Poikilocytes
Spherocytes
Basophilic Stippling
Howell - Jolly Bodies
Heinz Bodies
Schistocytes
Pencil Poikilocytes
Burr Cells
Acanthocytes
Hypersegmented Neutrophils
Target Cells - IDA, Hyposplenism, Sickle Cell / Thalassaemia
Tear Drop Poikilocytes - Myelofibrosis
Spherocytes - Hereditary Spherocytosis, MAHA, Warm AIHA
Basophilic Stippling - Lead Poisoning (Clover Leaf Morphology) , Thalassemia, Sideroblastic Anaemia , Myelodysplasia
Howell - Jolly Bodies AND Pappenheimer bodies - Hyposplenism
Heinz Bodies - G6PD Deficiency, Alpha Thalassaemia
Schistocytes - DIC, Mechanical Heart Valve , Intravascular Haemolysis
Pencil Poikilocytes - IDA
Burr Cells - Pyruvate Kinase Deficiency
Acanthocytes - Abetaproteinemia
Hypersegmented Neutrophils - Megaloblastic Anaemia
Lead Poisoning Associated with what Symptom?
Neuropsychiatric
Abdominal Pain
Peripheral Neuropathy
Intravascular Hemolysis Causes ? (So Schistocytes in Blood Film)
G6PD Deficiency
Red Cell Fragmentation - TTP, DIC, HUS
PNH
Cold AIHA
Extravascular Hemolytic Anemia Causes? (No schistocytes in blood film)
Warm AIHA
Hereditary Spherocytosis
Hemolytic disease of the newborn
Haemoglobinopathy - Sickle Cell, Thalassemia
Triad of HUS
MAHA
Thrombocytopenia
Renal Failure AKI
Which Enzymes affected in Lead Poisoning
ferrochelatase and ALA dehydratase function.
Treatment for Lead Poisoning ?
Chelating Agents
dimercaptosuccinic acid (DMSA)
D-penicillamine
EDTA
dimercaprol
Drugs that Trigger Acute Intermittent Porphyria
Drugs which may precipitate attack
(Blood Problems Have A Sneaky Behaviour)
* Barbiturates
* Pill- OCP
* Halothane
* Alcohol
* Sulphonamides
* Benzodiazepines
Polycythemia Rubra Vera
Diagnostic Criteria
Low ESR and Raised Leukocyte ALP
JAK2 Positive + High Hematocrit (>0.52 Males or >0.48 Females) + High Red Cell Mass (>25%) + Mutation in JAK 2
JAK Negative then A1+A2+A3 + 1 more A OR 2 B
A1 - Raised Red Cell Mass OR Hematocrit
A2 - Absence of Mutation in JAK2
A3 - No secondary causes of Erythrocytosis
A4 - Palpable Splenomegaly
A5 - Presence of an acquired genetic abnormality (excluding BCR-ABL) in the haematopoietic cells
B1 - Thrombocytosis
B2 - Neutrophils elevated
B3 - Radiological Splenomegaly
B4 - Low EPO or Low Erythroid Colonies
Where do you see Chocolate Cyanosis ?
Methaemoglobinaemia - normal pO2, low SpO2
CO poisoning - low pO2, low or false normal SpO2
Cyanide poisoning - normal pO2 and SpO2
Causes of Hyposplenism (Holly Jowell Bodies and Siderocytes)
splenectomy
sickle-cell
coeliac disease,
dermatitis herpetiformis
Graves’ disease
SLE
amyloid
Ann Arbor Staging
I = 1 lymph node group
II = >1 lymph node groups, same side of diaphragm
III = >1 lymph node group on different side of diaphragm
IV = Mets
A = no systemic symptoms other than pruritus
B = weight loss > 10% in last 6 months, fever > 38c, night sweats (poor prognosis)
Lugano Classification
(Double Check)
Lugano classification
Stage I - SINGLE lymphatic site (i.e., nodal region, Waldeyer’s ring, thymus, or spleen).
Stage IE - single extralymphatic organ or site (IE)
Stage II - 2 or more LN involvement on SAME side of Diaphragm
Stage IIE -Contiguous extra lymphatic extension from a nodal site
Stage III - 2 or More LN on BOTH SIDES of Diaphragm + MAY involve LOCALISED involvement of Spleen IIIS / Extranodal Organ IIIE / Both IIIE+S
Stage IV - DIFFUSE AND DISSEMINATED Organ Spread
Sickle Cell Anemia Crisis Types
Thrombotic (triggered by infection, dehydration etc …)
Acute Chest Syndrome - Most Common Cause of Death after Childhood
Anaemia -
Sequestration (Increased CORRECTED Reticulocytes + Splenomegaly)
Aplastic (Reduced CORRECTED Reticulocyte Count + associated with Parvovirus B19 )
Corrected Reticulocyte Count Formula
(Patients Hct/ Normal Hct) * % Reticulocyte
Latex Fruit Allergy Associated with
- Which Condition
- Which Fruits
Myelomeningocele spina bifida
Before a night of PASSION-filled MANGO-tango, I put my STRAWBERRY-flavoured condom on my BANANA, careful to leave out my 2 CHESTNUTS.
Then undressed the KIWI girl, expecting the size of PINEAPPLES but ends up with AVACADO’s
Mucosal / GI bleeding more common in Hemophilia A/B or vWD ?
Hemophilia B and vWD
Tumor Markers for
- Ovarian Cancer
- Teratoma
- Melanoma / Schwannoma
- SCLC, gastric cancer, neuroblastoma
CA 125
AFP
S-100
Bombesin
Superior Vena Cava Syndrome Features
Facial Swelling
Dyspnea
Visual Disturbance
Early Morning Headaches
Pulseless Jugular Venous Distension
Superior Vena Cava Syndrome Causes
SCLC , Lymphoma’s
Metastatic seminoma, Kaposi’s sarcoma
Breast cancer
Aortic aneurysm
mediastinal fibrosis
Goitre
SVC thrombosis
SVCO Management
**ONCOLOGICAL EMERGENCY **
Endovascular Stenting
Radical Chemotherapy or Chemo-radiotherapy > Stenting if Lymphoma / SCLC
Glucocorticoids often given although weak evidence
TACO vs TRALI Presentation and Management
TACO - HYPERtension + Pulmonary Edema (IV Furosemide + Stop Transfusion)
TRALI - Non Cardiogenic Pulmonary Edema due to activation of host neutrophils increasing vascular permeability
HYPOtension + Hypoxia
(Oxygen + IV fluids for BP + Supportive Care)
Hereditary Angioedema
- Acute Attack Treatment
- Screening Tests
- Prophylactic
- Presentation
- IV C1 Esterase Inhibitor Concentrate Infusion –>
FFP - C4 is THE reliable test
C1 Esterase INH is low in Acute Attacks - Anabolic Steroid -Danazol
- Painless / Non Pruritic Swelling –> Painful Macular Rash
Abdominal Pain from Abdominal Visceral Edema
Antiphospholipid Syndrome Treatment in Pregnancy
Low Dose Aspirin once Pregnancy Confirmed on Urine
LMWH once FETAL HEART SEEN –> discontinued at 34 weeks
What do we do to minimize vJCD via blood product ?
- late 1999 onward, all donations have undergone removal of white cells (leucodepletion) in order to reduce any vCJD infectivity present
- from 1999, plasma derivatives have been fractionated from imported plasma rather than being sourced from UK donors.
- from 2004 onward, recipients of blood components have been excluded from donating blood
Bovine Spongiform Ecephalopathy (BSE)
Associations of VTE
Central Venous Catheters (Femoral > Subclavian)
Puerperium
3rd Generation OCP
Hormone Replacement Therapy (E+P >E)
Antipsychotics - Olanzapine
Investigating for Allergies ?
Skin prick: food allergies and pollen.
Contraindicated in anaphylaxis and patients on oral antihistamine
Skin patch: contact dermatitis
RAST (Serum Specific IgE) : all others ie food allergies, pollen, venom etc
Warm AIHA
- Causes
- IgG or IgM associated
- What type of Hypersensitivity ?
- What’s Evan’s Syndrome ?
- Treatment
Neoplasm - CLL, NON HODGKIN LYMPHOMA
Connective Tissue Diseases - SLE
Drugs - Ceftriaxone, Piperacillin
HIV or Viral Vaccines
ASSOCIATED WITH PSC
IgG
Type 2 Hypersensitivity
AIHA + Autoimmune Thrombocytopenia = Evans Syndrome
Transfuse INCOMPATIBLE blood
Corticosteroids
Rituximab
Splenectomy
Hematopoietic Stem Cell Transplant
Cold AIHA
- Causes
- IgG or IgM associated
- What type of Hypersensitivity ?
- What’s Evan’s Syndrome ?
- Treatment
- Primary (Cold Agglutinin Disease)
Secondary -
EBV, CMV, Mycoplasma
Lymphoma, Wladenstrom’s
Drugs - Lenalidomide
IgM
COMPLEMENT AND MAC ?????
Causes of Sideroblastic Anemia
MALT
Myelodysplasia
Alcohol
Lead Poisoning
TB drugs
Causes of TTP
Post Infection
Pregnancy
SLE
HIV
Drugs: Ciclosporin,
OCP, Penicillin, clopidogrel, Acyclovir
Pentad for TTP
Fever
Altered Mental Status
Thrombocytopenia
MAHA
AKI
Urine colour changes to dark in which conditions in Hematology
PAPA mnemonic
1) Phenylketonuria
2) Alkaptonuria
3) Paroxysmal nocturnal haemoglobinuria
4) Acute intermittent porphyria
Hereditary Spherocytosis
- Inheritance
- Investigations
- Autosomal Dominant from Northern Europe
- EMA binding test and the cryohaemolysis test
If Atypical Presentation then Electrophoresis
Elevated MCHC
- Supportive + Transfusions
Splenectomy
EBV associated with which Cancers ?
H Pylori Associated Malignancy ?
Protozoal Associated Cancer
Nasopharyngeal Cancer
Hodgkin Lymphoma
Burkitt’s Lymphoma
Gastric MALToma - Antral Cancer
Protozoal = Burkitt
Side effect of Anastrozole
MOA
Side Effect
Aromatase Inhibitor
Reduces Peripheral Synthesis of Estrogen
ER+ AND Post Menopausal
DEXA scan prior as osteoporosis
Multiple Myeloma Prognostic Marker
B2-microglobulin
High Risk TLS patients which prophylactic Drug ?
vs Low Risk Patients ?
MOA of these drugs ?
High Risk - Rasburicase (Purine (Nephrotoxic) to allantoin (Non Nephrotoxic) converter via Recombinant Urate Oxidase)
Low Risk - Allopurinol
Prevent Uric Acid to Purine Conversion
NEVER GIVE RASBURICASE AND ALLOPURINOL together
Rx of ITP > Oral Prednisolone
Rx of TTP > Plasma Exchange
Rx of Hereditary Spherocytosis > Supportive + Folic Acid
CLL > FCR
CML > Imitinab
Waldenstor Gammaglobulinemia > Rituximab
Lead poisoning > DMSA
When conditions are platelet transfusion contraindicated ?
Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia
Thrombotic thrombocytopenic purpura
Platelet Transfusion Targets
Active Bleeding then <30x10^9
Active Bleed into Critical Sites like Orbit or CNS
<100x10^9
Leukemoid Reaction vs CML
In Leukemoid reaction
High LAP
toxic granulation (Dohle bodies) in the white cells
‘left shift’ of neutrophils i.e. three or fewer segments of the nucleus
Neutrophils Mature have Segmented Nucleus
Eosinophil = Two Lobed Nucleus
Basophil = Bean Shaped Nucleus
SVCO Treatment Immediate ?
Immediate
Dexamethasone injections
1) Cord compression in extra nodal Non Hodgkin’s lymphoma
2) SVC obstruction
Endovascular Stenting as definitive
CLL when to treat
Indications for treatment
progressive marrow failure: the development or worsening of anaemia and/or thrombocytopenia
massive (>10 cm) or progressive lymphadenopathy
massive (>6 cm) or progressive splenomegaly
progressive lymphocytosis: > 50% increase over 2 months or lymphocyte doubling time < 6 months
systemic symptoms: weight loss > 10% in previous 6 months, fever >38ºC for > 2 weeks, extreme fatigue, night sweats
autoimmune cytopaenias e.g. ITP
Irradiated Blood Products (T lymphocyte depleted) when to give ?
Irradiated if :
- Hodgkin
- Drugs like : Bendamustine or Fludarabine
- Autologous Stem Cell Transplant - 3 months post or 6 months if whole body irradiation given
Allogenic Stem Cell Transplant - Irradiated blood till
1) 6 months post +
2) off immunosuppression 3) No Clinical Evidence of GvHD
CMV Negative Blood Products when to give ?
1) Intra-uterine transfusions.
2) Neonates up to 28 days post expected date of delivery.
3) Pregnancy.
Drugs that cause Pancytopenia
ACS
Antibiotics: Trimethoprim, Chloramphenicol.
AED: Carbamazepine
Anti-rheumatoid: Penicillamine, Gold
Carbimazole
Cytotoxics
Sulfonylureas: Tolbutamide
Drugs Causing Drug induced Auto-immune Hemolytic Anemia ?
Common Pathogen Associated with Neutropenic Sepsis ?
Coagulase-negative
Gram-positive
Staphylococcus epidermidis
Neutropenic sepsis
Bacterial peritonitis
Bacterial endocarditis (withing 2 months of Valve replacement surgery)
Staphylococcus epidermidis associated with what pathologies ?
Neutropenic sepsis
Bacterial peritonitis from Dialysis
Bacterial endocarditis (withing 2 months of Valve replacement surgery)
Most Common Symptom Associated with SVCO
Dyspnea
Factor 5 Leiden Pathophysiology Explain
Antithrombin III –> Inhibit 12,11,9 and 7
Protein C and S –> Inhibit 5 & 8
Factor V Leiden - Gain of Function Mutation –> Activated Protein C RESISTANT –> Doesn’t allow Protein C to inactivate Factor 5 –> Thrombosis
Most Common Inherited Thrombophilia ?
Factor 5 Leiden
How does Heparin work ?
Stimulates Antithrombin III Inhibiting Factors 12,11,9 and 7
Why is Warfarin initially Procoagulant ?
Wafarin is a Vit K antagonist (10,9,7 and 2) but ALSO inhibit Protein C and S initially
So give bridging LMWH
Otherwise Wafarin Induced Skin Necrosis can happen
Pathophysiology of How Protein C and S are activated ?
Thrombin + Thrombomodulin –> Thrombin Thrombomodulin Complex
TTC activated Protein S via Gamma Carboxylation in Liver –> Protein S then Activate Protein C
High LAP vs Low LAP conditions
Raised in
myelofibrosis
leukaemoid reactions
polycythaemia rubra vera
infections
steroids, Cushing’s syndrome
pregnancy, oral contraceptive pill
Low in
chronic myeloid leukaemia
pernicious anaemia
paroxysmal nocturnal haemoglobinuria
infectious mononucleosis
Chemotherapy induced Nausea and Vomiting Antiemetics
(check though again)
Give Metoclopramide if Low Risk Unless _________
2nd Line Domperidone
3rd Line Ondansetron + Dexamethasone
Triptan - (An 1- Agonist)
Cyproheptadine (Di - 2) Antagonist
Ondansetrone - (Tri - 3) Antagonist
AML Poor Prognostic Factors ?
Poor prognostic features AML(mnemonic) :
Age > 60 years
Myeloblast > 20% blasts after first course of chemo
Location by cytogenetics: deletions of chromosome 5 or 7
When to discharge patients post anaphylaxis ?
2, 6, 12 hours
1 adrenaline shot, 2 OR Previous Biphasic Reaction, >2 OR If Severe Asthma , Late Night Presentation or Slow Release
CLL most common Cells to Proliferate ? B Cells or T cells ?
CLL - Smudge B cells causing Hypogammaglobinemia
BRCA1/2 on Which Chromosomes ?
Which is more associated with Prostate Cancer ?
BRCA 1 - 17 (Ovarian)
BRCA 2 - 13 (Prostate)
BRCA 2
Gartner Syndrome ?
1. Mutation Which Gene on Which Chromosome ?
- Extra-Colonic Manifestations
Mutation of APC on Chromosome 5
Skull Osteoma
Thyroid cancer
Epidermoid cysts
Cryoglobulinemia
- Types
- Symptoms (SKIN)
- Investigations
- Treatment
Type 1 -
Monoclonal (IgG or IgM)
MM or Waldenstrom macroglobulinaemia
a/w Raynauds
Type 2
Polyclonal
Hep C / Sjogren / RA / Lymphoma
Type 3
Polyclonal
Sjogren / RA
Skin
T1 - Acrocyanosis , Livedo Reticularis , Raynaud’s
T2 - NON BLANCHING Macules and Papules (due to antibody/antigen deposition within vessels and recruiting complement causing leukocytoclastic vasculitis
Kidney -
MPGN , Thrombosis
Intra-articular -
Mixed - Arthralgia
Nerves -
Mixed - Mononeuritis Multiplex
- Low C4 and RA titers in Mixed Type
High ESR
- Hep C Treatment
Suppress B cells with Rituximab –> Plasma Cells –> Abnormal Ig
Plasmapheresis
Treatment of ITP ? vs Treatment of TTP ?
Repeat Platelet count if >30x10^9 + Safety Net (avoid contact sports if <50x10^9)
If
Injury Prone Profession or Impact on QoL
Frequent Symptoms
1st Line Prednisolone (BONE MARROW ASPIRATE BEFORE IF SUS of Malignancy)
2nd Line IVIG
Tranexamic Acid if Menorrhagia
If No response after 3 months of Steroids then consider splenectomy or Mycophenolate
TTP
Plasma Exchange with FFP in the meantime
If Acute / Idiopathic TTP with Cardiac or Neurological Impairment OR REFRACTORY = Rituximab
Referral Criteria for ITP ?
Nose Bleed >20 mins
Prolonged Gum Bleeding
Hematuria or Malena
Following Trauma to Head
ITP causes in Kids vs Adults ?
Kids - Post Live Vaccination (MMR)
Adults - Recent Viral Infection
In ITP where do the Antibodies attack ?
Glycoprotein IIIb/2a
OR
Ib-V-IX complex.
Vitamin B12 Deficiency Treatment
1mg IM Hydroxocobalamin 3 times a week for 2 weeks then Once / 3 months
Stop once normalized
Life Long if Pernicious or Celiac
If Neurological Impairment :
1mg Hydroxocobalamin IM on alternate days until no further improvement –> 1mg / 2 months for lifelong (if secondary to Pernicious or Celiac)
Gold Standard Investigations for Hematological Malignancies (AML,ALL,CML,CLL)
ALL- bone marrow biopsy
AML - bone marrow biopsy (look for myeloblasts)
CLL - flow cytometry/ immunophenotyping
CML - FISH/PCR to look for BCR-ABL gene
Translocation (11:22) in ?
Ewing Sarcoma
Facts about Skin Prick , RAST and Skin Patch Testing
Skin Prick Test:
1- Easy to perform
2- Inexpensive
3- Use control (Histamine’+’ and Sterile water ‘-‘)
4- Read after 15 min
5- Useful for food allergy and pollen
6- Use diluted antigen and the pierce the skin
7- +Ve test is formation of wheal
RAST:
1- Check amount of IgE to specific Ag
2- Result from 0 ‘-Ve’—– to—– 6’ +Ve’
3- Useful in food allergy, inhaled pollen, bee/wasp
4- Used if skin prick can not be used
Skin Patch Test:
1- Useful for contact dermatitis
2- need dermatologist
3- Read after (48+48)hours
4- Test allergen and irritant
When would you investigate for Li-Fraumeni Syndrome ?
*Individual develops sarcoma under 45 years
OR
*First degree relative diagnosed with any cancer below age 45 years and another family member develops malignancy under 45 years or sarcoma at any age
Polycythemia Rubra Vera associated with Low or High ESR ?
Low ESR
How does Celiac Disease Cause Hyposplenism
excessive loss of lymphocytes through the inflamed enteric mucosa, leading to spleen’s reticuloendothelial atrophy
Which Blood Group is for Universal Donor for RBC and FPP ?
O - is universal donor and AB + is universal recipient for whole blood but vice versa for FFP.
What organism to Screen before starting Rituximab ?
Hepatitis B
Capecitabine is the Oral Form of what drug ?
5FU - Pyrimidine Antagonist
How is CLL (Monoclonal B cell proliferation) different to MM
MM
1. A pleuripotent stem cell proliferates –> multiple abnormal plasma cells
2. Cytogenic progression is more common –> risk of transformation to AML
3. More varied B cells –> more varied cytokine release –> more varied systemic features eg osteoclast-activating cytokines causing bony lytic lesions
CLL
1. A single committed B cell proliferates –> monoclonal B cell proliferation
2. Cytogenic progression is less common but a notable risk = Richter’s transformation –> high grade Lymphoma eg DLBCL
3. Body recognizes abnormal B cells and gathers them in the lymph nodes/spleen –> Lymphadenopathy (LAD). Progression of LAD/splenomegaly is one of the indications for treatment.
Multiple Myeloma vs MGUS vs Waldenström
Macroglobulinemia
MM
IgG > 30 g/l
>10% plasma cells on bone marrow biopsy
Elevated B2 Microglobulin and Lower Albumin (worse prognosis)
+ CRAB
MGUS
<10% plasma cells on bone marrow biopsy
Normal B2 Microglobulin
No CRAB
Waldenström Macroglobulinemia
IgM K subtype (not IgG)
Cryoglobulinemia Type 1 - Acracyanosis, Raynauds Phenomenon, Cold AIHA (DAT+), Hyperviscosity Syndrome Triad ( Visual, Bleeding and Neurological)
HEPATOSPLENOMEGALY unlike MM
No Bone Pain
BUT has Lymphoplasmaocytic Lymphoma + NEUROPATHY (IgM attacks Myeline Sheath)
> 10% Lymphoplasmocytic Cells on Bone Marrow Biopsy - CD19/CD20/CD22 +
Treatment -
Plasmapharesis
Plasma exchange
IVIG
Chemo - Rituximab based
Key facts about MM (just in case to remember)
MM–> ALL
Type 2 RTA “Proximal” - Fanconi Syndrome
Not seen on Bone Scan - X ray for Lytic Bony Lesions
Multinucleated Giant Cells on Biopsy on BJ deposition in the Tubules (not toxic to glomerulus)
IgGk –> IgA –> K or Lamda
REDUCED Anion Gap Metabolic Acidosis
Beta 2 Microglobulin –> Higher = Worse Prognosis
Albumin Level = Lower = Worse Prognosis
Serum ALP –> Normal
Histopathology = Monoclonal >10% Clock Face Chromatin , Abundant RER , Prominent Golgi , Perinuclear Halo, Peripheral Nucleus
Immunohistochemistry - CD138 +
If its not JAK2 mutation for ET then what else is the mutation ?
CALR (calreticulin)
If its not JACK its CARL
In Sickle Cell Crisis what is the prophylactic drug we give to reduce Crisis ?
Hydroxyurea (increase HbF levels) and analgesia managed by Morphine
Benign Neutropenia common in which ethnicity ?
Black Africans or Afro-Caribbeans
Hairy Cell Leukemia Facts
1) Clinical Features
2) Bone Marrow Aspirate
3) What stain
1) pancytopenia
splenomegaly
skin vasculitis in 1/3 patients
2) ‘dry tap’ despite bone marrow hypercellularity
3) Tartrate resistant acid phosphotase (TRAP) stain positive
Management
chemotherapy is first-line: cladribine, pentostatin
immunotherapy is second-line: rituximab, interferon-alpha
Poor Prognostic Factor for Hodgkin Lymphoma
Male >45
Stage 4
WBC > 15000 or Lymphocytes <600
Hb <10.5
Albumin < 40
Poor prognostic factors for CLL
Male >70
lymphocyte count > 50
prolymphocytes comprising more than 10% of blood lymphocytes
lymphocyte doubling time < 12 months
raised LDH
CD38 +
TP53 mutation
Deletion of Long Arm of 13q = Good Prognosis
Deletion of Short Arm of 17p = Poor Prognosis
Treatment for PNH ?
Eculizumab (Inhibit C5 Convertase so no MAC)
If Given Neisseria Meningitides Vaccine
Hematopoietic Stem Cell Transplant if Aplastic Anemia
Which Gene Mutations in Which Chromosomes and cause what Pathologies
- ALK
- C-KIT
- EGFR
- KRAS
ALK ch 2 = adenocarcinoma lung
C-KIT ch 4 = (GIST) and AML
EGFR ch 7 =RCC and NSCLC
KRAS. ch 12. = pancreatic cancers
Treatment of Methylglobinemia ?
Congenital = Ascorbic Acid
If Severe - MethylBlue but CI in G6PD
Translocations and Associations
Indolent
- Follicular -
T(14:18)
BCL2
Hepatosplenomegaly - Marginal Zone -
BCL10
H Pylori
Salivary and Thyroid Gland involvement
Aggressive
- Mantle Zone
T(14:11)
BCL1
Cyclin D
- Burkitt’s Lymphoma
T(14:8)
cMYC
- DLBC
BCL6
EBV + HIV
ALL Good vs Bad Prognostic Factors
Good - Bad
L1 - L3
Low WBC - High Wbc
Undiff - B or T differentiation
hyperdiploidy-HYPO diploidy
t1:19/11:21 - T9:22
Female - Male
2-10 - <2 or >10
