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Hematopathology I Flashcards

1
Q

Pancytopenia

A

Major Causes
Aplastic anemia
Tumor in bone marrow
Marrow fibrosis

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2
Q

Pancytopenia

A

Major Causes

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3
Q

Pancytopenia

A

a

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4
Q

Neutrophilia

A

a

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5
Q

Neutropenia

A

a

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6
Q

Agranulocytosis

A

a

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7
Q

Leukemoid Reaction

A

a

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8
Q

Leukoerythroblastic reaction

A

a

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9
Q

Myelofibrosis

A

a

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10
Q

Extramedullary hematopoeisis

A

a

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11
Q

Chronic Myelogenous Leukemia

A

Relative Frequency

Age Distribution

Peripheral Blood findings

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

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12
Q

AML

A

Relative Frequency

Age Distribution

Peripheral Blood findings

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

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13
Q

Myelodysplastic syndrome

A

Relative Frequency

Age Distribution

Peripheral Blood findings

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

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14
Q

Acute lymphoblastic Leukemia

A

Relative Frequency

Age Distribution

Peripheral Blood findings

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

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15
Q

Chronic Lymphocytic leukemia

A

Relative Frequency

Age Distribution

Peripheral Blood findings

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

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16
Q

Plasma Cell myeloma

A

Relative Frequency

Age Distribution

Peripheral Blood findings

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

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17
Q

Neutrophilia

A

Major Causes

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18
Q

Neutropenia

A

Major Causes

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19
Q

Agranulocytosis

A

Major Causes

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20
Q

Leukemoid Reaction

A

Major Causes

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21
Q

Leukoerythroblastic reaction

A

Major Causes

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22
Q

Myelofibrosis

A

Major Causes

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23
Q

Extramedullary hematopoeisis

A

Major Causes

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24
Q

Myelofibrosis

A

Major Causes
- Fibrosis of marrow
- Due to Chronic myeloproliferative disease
Metastatic tumors or lymphomas can also cause this

Radiation, chemicals, autoimmune also cause

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25
Q

Extramedullary hematopoeisis

A 
Major Causes
=
- Hematopoietic cell production outside bone marrow
- Primarily Spleen or Lymph nodes/liver
Chronic myeloproliferative neoplasm
Severe hemolytic anemia
Marow replacement

Not observed in marrow aplasia

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26
Q

AML

A

Relative Frequency

Age Distribution

Peripheral Blood findings
- Accumulation of immature myeloid precursors

Cytogenic abnormalities

Prognosis

Laboratory Features

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27
Q

Myelodysplastic syndrome

A

Relative Frequency

Age Distribution

Peripheral Blood findings
- Immature and defective hematopoiesis

Bone marrow findings

Cytogenic abnormalities

Prognosis
- Increased risk of becoming AML

Laboratory Features

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28
Q

Acute lymphoblastic Leukemia

A

Relative Frequency

Age Distribution

  • Children
  • Good prognosis

Peripheral Blood findings
- Acute lymphoid precursors

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

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29
Q

What does the evaluation of hematopoietic disorders begin with?

A

Peripheral blood smear

Percentage and number of erythrocytes and myeloid precursors

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30
Q

What are categories of white cell disorders?

A

Proliferative or Leukopenia

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31
Q

What is leukopenia?

A

Occurs as a result of increased consumption of white blood cells

Supression of myelopoeisis

Replacement of normal hematopoietic precursors

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32
Q

What is a monoclonal gammopathy?

A

Presence of immunoprotein from one clone

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33
Q

Neutrophilia

A

Major Causes

  • Reduction in number of neutrophils
  • Inadequate granulopoiesis (aplastic anemia)
  • Ineffective granulopoiesis (B12 def, MDS)
  • Accelerated removal (infection/immune mediated)
  • Replacement of marrow
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34
Q

What is a sign of neutropenia?

A

Infected gums

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35
Q

Neutrophilia

A

Increase in PMNs

  • Reactive (Demargination, Mobilization, Increased production)
  • Neoplastic
36
Q

Neutropenia

A

Major

  • Reduction in number of neutrophils
  • Inadequate granulopoiesis (aplastic anemia)
  • Ineffective granulopoiesis (B12 def, MDS)
  • Accelerated removal (infection/immune mediated)
  • Replacement of marrow
37
Q

Leukemoid Reaction

A 
Extreme Leukocytosis
>50,000
-Resembles leukemia
Due to:
STRESS/INFECTION
38
Q

AML

A

Malignant Clonal Expansion
Relative Frequency

Age Distribution

Peripheral Blood findings

  • Accumulation of immature myeloid precursors
  • BLAST with AUER ROD

Cytogenic abnormalities

Prognosis

Laboratory Features

39
Q

Acute lymphoblastic Leukemia

A

Relative Frequency

Age Distribution

  • Children
  • Good prognosis

Peripheral Blood findings
- Acute lymphoid precursors

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

40
Q

What are some toxic changes?

A

Toxic granulation

41
Q

What is a dohle body?

A

A pale blue structure in cytoplasm

42
Q

What is seen in flow cytometry of AML?

A

CD13, CD33, CD117

43
Q

What is an auer rod?

A

Needle accumulation of red granular material
- Myeloperoxidase

NEVER in LYMPHOID

44
Q

AML

A

Malignant Clonal Expansion
Relative Frequency

Age Distribution

  • ADULTS
  • 20% of childhood leukemias

Peripheral Blood findings

  • Accumulation of immature myeloid precursors
  • BLAST with AUER ROD

Cytogenic abnormalities
-t(15:17)

Prognosis

  • 60-80% reach remission
  • 25% 5 year survival
  • 65% in
45
Q

What do you use a myeloperoxidase stain for?

A

Positive for myeloid leukemias

NEVER LYMPHOBLASTS

46
Q

What is the cytogenic abnormality of AML?

A

t(15:17) for better prognosis
- But acute promyelocytic leukemia

Use standard cytogenic techniques

47
Q

What do you see in acute myelomonocytic leukemia?

A

Monocytic blast

  • Large cell with abundant cytoplasm
  • Azurophilic granulation

Promoncyte:
-Irregular/convoluted nuclear configuration
- More granulation
-Myeloid Blast: Smaller cells, round/oval nuclei
scant cytoplasm

48
Q

What do you see in Promyelocytic leukemia?

A

Blasts: Kidney shaped
MIcrogranular variant
Hypergranular variant: Intense coarse azurophilic granules

Faggot cells (bundle of sticks)

ATRA: Induces differentation=

49
Q

How do you treat AML with t(15:17)

A

This is promyelocytic leukemia

Treat with ATRA

50
Q

Acute lymphoblastic Leukemia

A

Relative Frequency

Age Distribution

  • Children MOST COMMON CANCER in children 1-7
  • Good prognosis

Peripheral Blood findings

  • Acute lymphoid precursors, lymphoblasts
  • Anemia/thrombocytopenia

Bone marrow findings

Cytogenic abnormalities

Prognosis

Laboratory Features

51
Q

What are the presenting features of ALL?

A

Fatigue, infections, bleeding
Bone pain
Organ Infiltration
CNS symptoms

52
Q

What is the cure rate of ALL?

A

Most achieve remission (85% of children)

40% in adults

53
Q

What is the cytochemical stain for ALL?

A

Myelo Negative

Flow cytometry is mostly B-cell
B cell: CD19, CD79a, CD22

Immaturity: TdT, CD34

54
Q

Chronic Myelogenous Leukemia

A

Relative Frequency

Age Distribution
- Median Age: 55 years

Peripheral Blood findings

  • Marked leukocytosis
  • Eosinophilia IS COMMON
  • Basophilia is INVARIABLY PRESENT

Bone marrow findings

Cytogenic abnormalities
t(9:22) Philadelphia chromosome (BCR-ABL)

Prognosis
- Imantinib is a better prognosis

Laboratory Features

55
Q

Myelodysplastic syndrome

A

Relative Frequency
Characterized by cytopenias, ineffective hematopoiesis, dyspoiesis

Increased risk for AML transformation

Age Distribution

Peripheral Blood findings
- Immature and defective hematopoiesis

Bone marrow findings

Cytogenic abnormalities

Prognosis
- Increased risk of becoming AML

Laboratory Features

56
Q

Chronic Lymphocytic leukemia

A

Relative Frequency

Age Distribution
>60yo
M>F

Generalized lymphadenopathy 50-60%

Peripheral Blood findings

  • B-cell neoplasm
  • Monotypic kappa or lambda light chains

Bone marrow findings

Cytogenic abnormalities
- Aberrantly expressed CD5

Prognosis

Laboratory Features

57
Q

What are T cell lineage markers?

A

CD3, CD5, CD2, CD7, CD4, CD8

58
Q

What are cytogenic abnormalities of Favorable B-ALL?

A

High Hyperdiploid (>50)

T(12:21) TEL-AML

59
Q

What are unfavorable cytogenic abnormalities B-ALL?

A

Hypodiploid
t(9:22) BCR-ABL
11q23

60
Q

What are diagnostic cells seen in CLL?

A

SMUDGE CELLS

- Degenerating material of dying lymphocytes

61
Q

What are the bone marrow findings in CLL?

A

Nodular

Interstitial

Diffuse

Small round lymphocytes

62
Q

What is dysopoeisis?

A

Abnormal morphologic features of myeloid, erythroid, megakaryocytic

63
Q

What are features of myelodysplastic syndrome?

A

Elderly

Infection, fatigue, hemorrhage

50% asymptomatic

64
Q

What does prognosis depend on for myelodysplatic syndrome?

A

Blast percentage
Cytogenic abnormalities
Degree of cytopenias
Age

65
Q

How do you classify MDS?

A

Cytologic

  • RInged sideroblasts (erythrocytes)
  • Dyspoiesis in one, two, or three cell lines
  • Cytogenic abnormalities
66
Q

What is a classic feature of blood smear in MDS?

A

Dimorphic red cell population (normochromic, hypochromic)

67
Q

What is a hypolobate PMN?

A

One or two lobes instead of 3 -5

68
Q

What distinguishes dysmegakaryopoiesis?

A

Small hypolobate megakaryocytes with nuclei spaced far apart

69
Q

What are the cytogenics of MDS?

A

Chromosomal Abnormalities

Trisomies/deletions are common

Specific translocation are UNCOMMON

70
Q

What are the types of chronic myeloproliferative neoplasms?

A

Chronic myleogenous leukemia

Polycythemia vera

Essential thrombocytopenia

Primary myelofibrosis

71
Q

What is the mutation seen in some myeloproliferative neoplasms?

A

JAK2 V617F mutations

Seen in pts with polycythemia vera and half of patients with essential thrombocythemia/primary myelofibrosis

72
Q

How does V617F mutation function?

A

It makes JAK active to phosphorylate downstream signaling molecules in the absence of signal to do uncontrolled proliferation (STATS)

73
Q

What are signs of essential thrombocythemia?

A

Chronic myeloproliferative disorder

Thrombosis to hemorrhage

Splenomegaly in 50% patients

Adult Disease 50-60 year olds

Rarely transforms to AML or Myelofibrosis

74
Q

What do you seen in essential thrombocythemia?

A

ATYPICAL MEGAKARYOCYTES (staghorn cells)

HIGH SURVIVAL

75
Q

What age is primary myelofibrosis hit?

A

MIddle age and elderly

Progressive development of splenomegaly

SURVIVAL 3 years

5-20% progress to acute leukemia

76
Q

What is the blood morph of primary myelofibrosis?

A

Tear drop RBCs

Leukoerythroblastic reaction- Immature myeloid cells and nucelated RBCs

77
Q

What are the stages of Primary myelofibrosis?

A

Cellular stage :hypercellular

Fibrotic stage: Hypocellular marrow, increased marrow fibrosis, intrasinusoidal hematopoiesis

78
Q

What are the stages of Primary myelofibrosis?

A

Cellular stage :hypercellular

Fibrotic stage: Hypocellular marrow, increased marrow fibrosis, intrasinusoidal hematopoiesis

79
Q

What is the monoclonal immunoglobulin called in plasma cell neoplasms?

A

M-protein, monoclonal protein

80
Q

What are the plasma cell neoplasms?

A

Monoclonal gammopathy of Undertermined significance

Solitary myeloma

Plasma cell Myeloma (worst)

81
Q

What are features of MGUS?

A

Over 70

Incidental

25% progress to disease over 20 years

82
Q

What are characteristics of solitary myeloma?

A

Solitary bone lesion

Extraosseous: Lung/pharynx or nasal sinuses

Treated with local radiation

83
Q

What are characteristics of plasmal cell myeloma?

A

Bone Marrow

Monoclonal IgG, IgA, light chain protein in urine

See normal plasma cells (clock face chromatin

Symptomatic: HyperCalcemia (renal insu, anemia, bony LYTIC lesion)

Asymptomatic: M-protein in serum, bone marrow involvement
NO END ORGAN DAMGE

84
Q

What do you see in plasma cell myeloma?

A

Lytic lesions of bone

Rouleaux: Linear arrays of RBCS

85
Q

What is the prognosis of plasma cell myeloma?

A

> 8 year survival

Prognosis: Cytogenic, performance, LDH, Age

86
Q

What are the therapies for plasma cell myeoma?

A

Immune modulators and proteasome inhibitors and autologus stem cell transplant

Path II (11 decks)

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