Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonology > Hematology/Oncology (WBC,s) > Flashcards

Hematology/Oncology (WBC,s) Flashcards

1
Q

What is the diffrence between leukemia and lymphoma?

A

Leukemia- cancer of wbc in blood (abnormal wbc in blood)
lymphoma - cancer of wbc in the ymph nodes (abnormal wbc in lymphnodes)

Lymphoma is a solid tissue mass (lemon)
leukemia is liquid (in blood,lemonade)

lemon can be made into lemonade and lemonade seed in lemon

so lymphoma can give rise to leukemia and leukemia to lymphoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Explain lymphocytes.

A

Lineage-lymphoid
agranulocytes

1) NK cells
2) T cells ( form in BM, mature in thymus)
3) B cells( form in BM, mature in MALT/ GALT (peyer patches)

circulation/bone marrow - leukemia
lymph nodes / maturing organs - lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Can you diffrentiate between T and B cell under the microscope?

A

No, its impossible.
We diffrentiate by flow cytometry (Detection of cluster of diffrentiation) (CD - basically the ID of the cell)

NK cells- CD16, CD56

T cells- Helper- CD3, 4
killer- CD3, 8

B cells - MHC2 CD19 and 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some Benign Leucocyte reactions? (Reactions that are not diorders)

A 
Eosinophilia
neutrophilic leucocytosis
basophilia
monocytosis
etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the diffrence between normal division and neoplastic division/

A

Neoplasia on its own doesn’t mean malignancy. Neoplasia can be benign or malignant
Neoplasia is monoclonal (a single cell decides to go bezerk)
it is irregular and not reversible

normal division is regular, reversible and include many cells (polyclonal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the Hematological Malignancies (all the malignancies related to the hematology) (high WBC)

A

Leukemia ( in the blood/BM)

1) Acute Lymphoblastic Leukemia (ALL) (newborn to 14 years)
2) Acute Myeloblastic Leukemia(AML) (14-60)
3) Chronic Lymphocytic leukemia (CLL) (>60)
4) Chronic myelocytic Leukemia (CML) (14-60)

Lymphomas (in the LN)
Hodgkins and Non-Hodgkins

Myeloma (multiple Myeloma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the main diffrences between Acute and Chronic leukemias?

A

Acute-
young patients
Cells are immature (blasts)
cell lose ability to diffrentiate byt retains ability to divide

chronic
older patients
mature cells (cytes)

for example

ALL- since its lymphoblastic (lymphoid lineage) we know that when maturing they will form lymphocytes (T and B cells)
but the immature cells will lose diffrentiating abilitya and we will have a lot of immature lymphoid lineage cells
These will be Medium sized
agranular (lymphoid lineage doesn’t form any granulocytes so obviously immature cells will also not have granules)
Scanty cytoplasms (because mature T and B cells also doesn’t have much cytoplasms)

AML- Myeloid lineage so they are the immature forms of the Granulocytes
They are larger. Granules present and more cytoplasm

now chronic-

CLL- Lymphocytes will be seem (Chronic=mature)
smudge cells

CML - Myelocytes,neutrophils and basophils high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain Acute Leukemias :)

A

We will have BLASTS.

Reasons for development of leukemias- Both genetic and environmental
Antineoplastic agents
radiation
Hodgkin lymphoma
benzene 
multiple myeloma

Acute Leukemias asre MONOCLONAL disorders of early stem cells of either MYELOID or LYMPHOID origin

these Myeloblasts and Lymphoblasts Replicate and

1) Replace most of the bone marrow cells, crowding out normal haematopoesis
this will result in pancytopenia (BM wll have trouble doing normal haematopoesis as the abnormal one is crowding)
due to pancytopenia
RBC low-anaemia
WBC low-INfections
Patelets low-Bleeding

2) Then they Enters the peripheral blood
3) metastasize throughout the body (further lead to splenomegaly, Hepatomegaly, Lymphomas,bone pain)

platelets less than 100,000
WBC less than 10,000 or more than 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain the clinical features of the acute leukemias

A

1) painless LN enlargement
2) testicular enlagment in ALL
3) bone pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can leukemias / lymphomas or other cancer leads to megaloblastic anaemias?

A

Due to high cell turnover (a lot of dividing and forminf cells) a lot of FOLATE is consumed by these cells leading to the high demand of folate and not enough for the RBC DNA synthesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are auer Rods?

A

Seen in the Blast cells Of AML (acute myeloid Leukemia) Myeloid are Granulocyte lineage

-in myeloblasts not monoblasts

Auer rods are clumps of azurophilic granular material that form elongated needles and can be seen in the cytoplasm of leukemic blasts under microscopic examination. They are composed of fused lysosomes and contain peroxidase, lysosomal enzymes, and large crystalline inclusions.

Immature Myeloid lineage cells will contain auer rods (myeloblasts not monoblasts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain Chronic Leukemias :)

A 
MONOCLONAL disorders of the LATE cells
Mature and smaller
can be identified easily
in older persons
Blasts cells are not seen or less than 10%

Onset of signs and symptoms are usually slower
lypadenopathy still seen
hepato and aplenomegaly also seen

platelets less than 100,000
WBC less than 10,000 or more than 100,000
basophilia can be seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Explain Acute Lymphoblastic Leukemia :) (ALL)

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do you mean by secondary AML?

A

CML can cause AML that means chronic myelocytic leukemia (meloid lineage ) (mature) can give rise to Acute one (immature)

in this case it is called secondary AML.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risk factors for the Acute Myelocyitic anaemia?

A

Acute ML means immature myeloid lineage cells
high cytoplasm and granular
Myeloid lineage —-1) Myeloblasts (have Auer rods that are peroxidase posiitive)
2) monoblasts

primary AML occurs due to Radiation, Bemzene, or antineoplastic agents

if nn of these agents then we call it the seconary AML that can be due to
Myelodysplastic Syndrome
Aplastic Anaemia
PNH
Myeloproliferative Disorders
Fanconi anaemia

AML will have gum Infilteration )M5 variant

all other symtoms are the same of the leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Classification of AML?

A

M0 to M7

most Important to learn
M2- Myeloblastic with Maturation t(8;22)
M3- Acute promyelocytic leukemia

M5 - monocytic gum infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is good and Bad prognosis?

A

A bad prognosis means there is little chance for recovery. Someone with a good or excellent prognosis is probably going to get better.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Explain Acute Promyelocytic leukemia. (aPML)

A

Specific subtype of AML
M3
The problem is not with the BLASTS cells (Myeloblasts)
but with promyeloblasts (one step further before division not Neuto mono baso)

auer rods present

t(15:17)

Complication- DIC syndrome

very good prognosis as it can be treated with Vitamin A (ATRA- All Trans Retinoic Acid) or Arsenic

vitamin A induces maturation of primitive promyelocytes- from neutrophils that will go apoptosis and will not continue to diffrentiate

however Vit A can cause Diffrentiaton syndrome]

Vitamin A also does not cause myelosuppresion (other cancer drugs do)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Explain Some clinical used of Vitamin A.

A
  • Treatment of Acne (but can cause abortion)
  • treatment of measles and low risk of blindness
  • Treatment of aPML (acute promyelocytic leukenmia)
  • treatment of Hairy Leukoplakia
  • retinitis pigmentosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Diffrentiation Syndrome?

Previously known as retinoic acid syndrome

A

Differentiation syndrome (DS; originally called “retinoic acid syndrome”) is a potentially fatal complication of treatment of acute promyelocytic leukemia (APL) with all-trans retinoic acid and/or arsenic trioxide

treatment- Give high dose of Dexamethasone (when doctors have no clue,they give corticosteroids)

stopping the ARTA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the treatment for Acute lymphoblastic Leukemia? (ALL)

A

First we should stabilize the symptoms of the patient to make them ready for the chemotherapy
for example if patient have
thrombocytopenia- do a platelet tranfusion
fever and granulocytopenia- blood culture+antibiotics
leucostasis- do leucopharesis

1) remission induction- Prednisone + Vincristine
2) consolidation- (maintainence)

high dose methotrexate

bone marrow transplant is the last resort

If the patient have a philadelphia chromosome translocation in ALL t(9:22) then we will give
Tyrosine Kinase Inhibitor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the treatment for Acute myelogenous Leukemia? (AML)

A

1) remission induction - give chemotherapy to suppress all cell lines (patient can become prone to infections)

cytosine arabinoside for 7 days + daunorubicin for 3 days

2) consolidation= same drugs

stem cell transplan== only for person less than 60 years

if aPML give retinoic acid

23
Q

What is post remission therapy (consolidation therapy)?

A

Postremission therapy is used to kill any cancer cells that may be left in the body.
It may include radiation therapy, a stem cell transplant, or treatment with drugs that kill cancer cells.
Also called consolidation therapy and intensification therapy.

24
Q

What can be the complictions for treatment of ALL?

A 
Chemotherapy given (drugs) can cause the Tumor lysis syndrome.
Direct testicular radiation can lower sperm count and cause infertility (so sperm sonation and preservation should be suggested)
25
Q

What can be the complictions for treatment of ALL?

A 
Chemotherapy given (drugs) can cause the Tumor lysis syndrome.
Direct testicular radiation can lower sperm count and cause infertility (so sperm donation and preservation should be suggested)
Intrathecal methotrexate and cranial irradiation can lead to cognitive disfunction
26
Q

What is tumor Lysis syndrome?

A complication of anticancer therapyies

A

Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream

A lot of cell killed at the same time–> high K+ and Phosphate and uric acid released in blood stream from the lysis cell—> bad for blood—–> kidney overworks to remove these substances—–> renal failiure

27
Q

Explain how Myelodysplatic syndrome can lead to AML?

A

MDS is the intermediate gateway between the normal state and the AML (almost 30% cases of MDS convert to AML)

here hypercellular bone marrow is seen
(not similar to aplastic anaemia in which pancytopenia is due to hypocellular BM)

dysplasia means pre cancerous

the whole reason for treatment is to prevent the MDS to convert to AML

Myelodysplastic syndrome is not the same as myeloproliferative disorders

Both are Myeloid lineage
but
in Myeloproliferative there is no cytopenia
and there is adequate maturation

in MDS there is cytopenia and inadequate maturation

28
Q

What is Myelodysplastic syndrome?

sad bone marrow

A

MDS is the stem cell disorder with ineffective haematopoesis, defect in maturation of cell of myeloid lineage (this include rbc. Granulocytes,wbc and platelets,
this is why we will have pancytopenia

MCV will be high because immature cells

It is acquired clonal disorder affecting stem cells
causes can be acquired or environmental

29
Q

Classify MDS.

A

1) Refractory Anaemia (Slowest subtype to progres to AML)
refractory anaemia- anemia inresponsive to treatment

2) Refractory Anaemia with ringed Sideroblasts
3) Chronic myelomonocytic
4) refractory anaemia with Excess blasts in transformation (fastest subtype to get converted into AML)

Unfavorable cases-
high % of blasts
(in acute leukemias >20% and in MDS<20% so if the number of blasts is increasing you are getting close to getting cancer/leukemia)

high no. Of cytopenias
high age
cytogenetic anomalies (chr 7)

Favourable cases-
5q (in females) or 20q deletion

30
Q

How can MDS be treated?

A

Supportive therapy
human growth factors
CHEMO
stem cell transplant (last resort)

31
Q

Chronic Myelogenous Leukemia

A 
Mature cells
older patients
non existent or very few blasts cell (less than 10% in BM)
small cells
onset is insidious

risk factor - ionising radiation in high doses
usually 40-60 years age

15% of adult leukemias

32
Q

What is the cause of CML?

A

T(9:22) translocation of the proto-oncogen “ABL”

ABL fuses with the Break cluster region (BCR) on ch 22

ABL(chr 9) + BCR (chr 22) ==> BCR-ABL fusion gene (on chr 22)

this is called the Philadelphia Chromosome

this philadelphia chromosome can lead to ALL or CML

BCR-ABL fusion gene—–.translation—–> BCR-ABL protien

100% of patients with CML have philadelphia chromosome

nut it is not specific because phil. Chr is also present in pattients with ALL

this protien form is a tyrosine kinase (all enzymes are protiens)
this tyrosine kinase will dirupt the cell function and will cause increased proliferation and decreased apoptosis

this is why we treat this with tyrosine kinase inhibitor
IMATINIB

33
Q

What are the three phases of CML

A

Chronic phase (most patiens are diagnosed here) asymtomatic or mild symptoms

accelarated phase - splenomegaly , basophilia , more immature cells are seen

Blast crisis - clinically it starts to behave like an acute leukemia
transfers to AML(70%) or ALL(30%)

34
Q

What is LAP test? (Leukocye alkaline phosphatase test)

specifically used for CML

A

A leukocyte alkaline phosphatase (LAP) test is a laboratory test that can be conducted on a sample of your blood. Your doctor can order it to measure the amount of alkaline phosphatase, a group of enzymes, in certain white blood cells.

Leukocyte alkaline phosphatase (LAP) is the term for alkaline phosphatase that’s found in leukocytes. Another name for leukocytes is white blood cells.

When your test results are available, your doctor will discuss them with you. They will help you understand what the results mean and discuss follow-up steps. Scores for the LAP test can range from zero to 400, with those between 20 and 100 being considered normal.

A score that’s higher than normal may be caused by:

leukemoid reaction
essential thrombocytosis
myelofibrosis
polycythemia vera

A score that’s lower than normal may indicate:

CML (because leukemic cells are useless)
aplastic anemia
pernicious anemia

If your doctor suspects you may have CML based on your test results, they will likely order a cytogenetic test. This will help them confirm their diagnosis.

35
Q

Explain Blast crisis.

A

A phase of chronic myelogenous leukemia in which tiredness, fever, and an enlarged spleen occur during the blastic phase, when more than 30% of the cells in the blood or bone marrow are blast cells (immature blood cells).

CML coverts to AML and behave like it
increased Basophilia is aldo seen

36
Q

What is Leukemoid reaction? (It is not leukemia)

A

It is a benign condition

It is an exaggerated responseof leucocytes against a microbial pathogen or response to stress

WBC> 50,000
could be wither Myeloid or Lymphoid origin

37
Q

How can we rule out CML id there is Leukemoid Reaction suring diagmosis?

A

Both wil have basophilia

However the LAP score is low in CML (the leucocytes are useless but high)

and high in leukemmoid recation (exaggerated response)

38
Q

What is Alkaline Phosphatase enzyeme?

A

Alkaline- Stable and works in Alkaline environment (basic)
phosphatase- an enzyme that removes phosphate group from a molecule

(Kinase adds a phosphate group :)

do not confuse it with Acid phosphatase that works best in acidic environment

39
Q

How can we use acid phosphatase to diffrentiate in acute lymphoblastic leukemia subtypes?

A

In B-ALL it is negative

T-aLL positive

40
Q

Where can you find Alkaline phophatase enzyme in the body?

A

Hepatobilliary and musculoskeletal system.

ALP is high in case of-

hepatobilliary diseases
hepatic cirrgoiss
leukemoid rxn (also LAP high)
Paget disease
osteomylasia
hyperthyroidism/parathyroid
pregnancy

ALP will be low in-

wilson disease
PNH
CML
hypothyroidism and menopause

41
Q

Leucocyte Alkaline Phosphatase?

A

Enxyme removing the Phosphate group in an basic environment in Mature Leucocytes

42
Q

Why leucocte ALP will be low in CML (even though the cells are mature?

A

Even though in CML the cells of the myeloid lineage is mature but it is cancer and in cancer we have a left shift.

These cells would no be as mature as normal cells

in leukemoid rxn the cells are fully mature and functional so high LAP

LAP high in
leukemoid rxn
polycythemia vera

low in-
CML
Apastic anaemia (because of pancytopenia)
pernicious anaemia

43
Q

Explain Tyrosine kinase inhibitors. (TKI) (-tinib) (imatinib)

A

Tyrosine kinase adds phophate group (ON-OFF switch)

It takes Phosphate group from ATP and gives it to a protien

Now the Tki,s Blocks the ATP binding site on the tyrosine kinase enzyme
so no phosphate tranfer to the protien

now for Imatinib the target protiens are different like
in
CML – BCR-ABL protien

These are teratogenic in nature so not given in pregnancy.

44
Q

Treatment of CML.

A

We use TKI’s

1) First Generation- Imatinib (all phases)
2) Second generation- Dasatinib (all phases), Nilotinib (cannot give in case of blast crisis), Bosutinib (never the first choice)
3) third- Ponatinib

we can also give Omacetaxine that is a more selective on BCR-ABL (after 2 or more TKI’s have failed)

45
Q

What is Leukostasis? To which type of leukemia is it related to?

A

Leukostasis happens because of high number of blasts in the blood
high viscosity= low tisseue perfusion that can lead to
stroke
cerebral ischemia
haemorrhage
sludge in pulmonary vessels-pulmonary effusion
DIC
tumor lysis syndrome

because its blasts cell it is realted to AML, ALL and CML(in case of blast crisis)

46
Q

how can we treat leukostasis?

A

Give hydroxyurea (in tumor lysis syndrome)
leukopharesis (to remove the blast cells)
Induction chemotherapy
Prophylaxis for tumor lysis syndrome by giving hydrate the patient and give allupurinol, rasburicase.
Brain radiation

47
Q

Explain chronic lymphocytic leukekmia. (CLL)

A

Lymphoproliferative disorder of high no of mature lookinf lymphocytes (that are of no use or incompetant0

If there is a solid lymph nodal mass (as lymphocyte goes to mature in lymph nodes) we will call it SLL

CLL/SLL as leukemia can lead to lymphoma and vice versa

Elderly caucasian male
usually asymptomatic

lymphocytosis (smudge cells seen)
lymphadenopathy
hepato splenomegaly
anaemia and thrombocytopenia is seen (n severe cases)

48
Q

Explain classification or prognosis of CLL (very important)

The Rai system

A

Stage 0 lymphocytosis with smudge cell risk low

Stage 1 lymphocytosis+adenopathy medium

Stage 2 lymphocytosis + hepatosplenomegaly mid

Stage 3 Anaemia high

Stage 4 thrombocytopenia high

49
Q

Can CLL lead to lymphoma?

A

Yes

10% of the people with CLL will have diffuse large cell lymphoma (aggressive form)

50
Q

What is Hairy cell leukemia?

A

Rare
Indolent (not aggressive,mild)
some say it is a subtype of CLL
Hairy cells —-> Mature B lymphocytes

Leukemic cell accumulate in the spleen
Leukemic cell will overcrowd other cell lines causing anaemia, leukopenia and thrombocytopenia

high risk for people who do farming and gardening

good prognosis

tretament-
supportive therapy
purine analogs (metabolites that mimic sttructure of purines) - Cladribine and pentostatin

BRAF inhibitors

51
Q

Why can leukemias cause anaemias and other pennias?

A

Leukemia itself can also cause anemia. As leukemia blood cells multiply rapidly, little room is left for normal red blood cells to develop. If your red blood cell counts drop too low, anemia can occur

52
Q

What happen when lymphoma occurs in mediastinum?

A

Airway Obstruction

Superior vena cava syndrome

53
Q

How can lymphomas lead to hypervisosity syndrome?

A

Some lymphomas can create IgM antibodies that can cause hv syndrome

Pulmonology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions