Hematology & Oncology Flashcards
Acute leukemia
- Bone marrow smear
Neoplastic proliferation of blasts in the bone marrow, which exhibits hypercellularity with > 20% blasts (leukemic cells)
Acute leukemia
- Hematopoiesis
Blasts (leukemic cells) “crowd out” normal hematopoiesis, thereby suppressing the proliferation of other hematopoietic precursors
Acute leukemia
- Peripheral blood smear: WBC
- Blasts (leukemic cells) enter the bloodstream and metastasize throughout the body
- Leukocytosis 2/2 large, immature cells with punched out nucleoli (blasts)
Acute leukemia
- Peripheral blood smear: RBC
Normocytic to macrocytic anemia
Acute leukemia
- Macrocytic anemia
Macrocytic anemia in the setting of folate deficiency 2/2 increased production of leukemic cells
Acute leukemia
- Peripheral blood smear: Platelets
Thrombocytopenia
Acute leukemia
- Peripheral blood smear: Platelets
Thrombocytopenia
Acute lymphoblastic anemia (ALL)
- Lymphoblast surface marker(s)
- Neoplastic proliferation of lymphoblasts (> 20%) in the bone marrow
TdT+ (Terminal deoxynucleotidyl transferase)
TdT
TdT - Enzyme responsible for adding nucleotides to the V, D, J regions of the antibody gene to generate antibody diversity
B-ALL
- Surface marker(s)
TdT+, CD10+ (CALLA), CD19+, CD20+
CALLA - Common acute lymphoblastic leukemia antigen
T-ALL
- Surface marker(s)
TdT+, CD1a+, CD2+, CD3+, CD4+, CD5+, CD7+, CD8+
CD3 - TCR complex
Cytogenetic abnormality a/w B-ALL in children
t(12;21)
Good prognosis
Cytogenetic abnormality a/w B-ALL in adults
t(9;22) = Ph+ ALL
Poor prognosis
Cytogenetic abnormality a/w B-ALL in infants
t(11;23)
Poor prognosis
B-ALL + T-ALL
- Clinical features of leukemic spread
- Generalized lymphadenopathy
- Hepatosplenomegaly
- BONE PAIN/TENDERNESS 2/2 bone marrow expansion by leukemic cells (blasts)
Site(s) of leukemic spread in B-ALL
- CNS, TESTES
- Treatment requires PROPHYLACTIC CHEMOTHERAPY (direct injection) to the SCROTUM and the CSF because chemotherapeutic agents do not cross the blood-testis and blood-brain barriers
Site(s) of leukemic spread in T-ALL
Skin
T-ALL
- Classic clinical presentation
Mediastinal/thymic mass in a young (teenage) boy
T-ALL = Acute lymphoblastic LYMPHOMA
T-ALL presents as a mediastinal/thymic mass that can compress surrounding structures (3), leading to specific clinical findings
- Great vessels - Superior vena cava syndrome
- Esophagus - Dysphagia
- Trachea - Dyspnea, stridor
Acute myelogenous anemia (AML)
- Myelobast marker(s)
- Neoplastic proliferation of myeloblasts (> 20%) in the bone marrow
- Myeloperoxidase (MPO)
- Crystal aggregates of MPO may be seen as AUER RODS (fuzed azurophilic granules)
Cytogenetic abnormality a/w APL (M3 AML)
t(15;17)
Translocation of the retinoic acid receptor (RARα) on chromosome 17 to the PML gene on chromosome 15
APL treatment
All-trans-retinoic acid (ATRA)
Normally, RARα plays a role in the proper differentiation of myeloid precursors. RARα interacts with RA to effect transcription of genes required for maturation.
t(15;17) produces an abnormal RAR that is unable to signal for differentiation of myeloid precursors. Disruption of RAR blocks maturation, and promyelocytes (blasts) accumulate.
Treatment with ATRA binds the abnormal RAR and stimulates the differentiation of myeloblasts into mature granulocytes, which eventually die; induces remission in about 90% of patients with APL.
APL treatment complication
DIC 2/2 Auer rods - Cytolysis of blasts releases Auer rods
Cytogenetic abnormality a/w acute myelomonocytic leukemia + bone marrow eosinophilia (M4eo)
EOSINOPHILIC AML
inv(16)
