Hematopathology - Wright Flashcards
What are the main types of CBCs you can order?
- CBC with no differential (no different types)
- CBC with automatic differential (computer given count)
- CBC with manual differential (lab techs manually verify cells present)
What values will you see on a CBC with differential?
- Total WBC (sum of 5 types of WBCs)
- Hct 3x the value of Hgb
- Absolute is the actual count of cells (these are what you really want to look at)
- Note: Platelets and WBCs are x 10^3
What is a bone marrow aspiration?
- Looks at the molecular genetics of a sample of the liquid part of the bone
- Uses flow cytometry
What is a bone marrow biopsy?
- Looks at the cell constitution of a sample of solid bone marrow
- Represents all cells
Where are megakaryocytes (precursors to platelets) produced? What do they do?
Inside the bone marrow - come from Megakaryoblasts–> Megakaryocyte
Get released into circulation & produce platelets (1,000-3,000)
What is the average lifespan of platelets?
8-9 days
Where are old platelets destroyed?
spleen and liver
Where are reticulocytes produced? What cells do they come from?
Inside the bone marrow
Hematocytoblast –> Proerythroblast –> Reticulocyte
How long does it take for a reticulocyte to mature? What nutrients are vital for this to occur?
1-2 days
Need Vit B12 and B9 (folic acid)
What hormone stimulates production of RBCs in the bone marrow?
Erythropoetin
Where is erythropoietin produced?
Kidneys and liver in response to low O2
Low circulating RBCs in the blood stream means there will be ____(higher/lower) unbound erythropoietin?
Higher (erythropoietin is bound by circulating RBCs)
T/F: Disruption of hematopoiesis can be malignant or non-malignant
True
What disorders of hematopoiesis are malignant?
- Leukemia
- Lymphoma
- Myeloma
- Myelodysplastic Syndrome
- Aplastic anemia
What disorders of hematopoiesis are non-malignant?
- Nutritional deficiencies
- Autoimmune disorders
- Infectious etiology
- DIC
- TTP
- Hypersplenism
What malignant hematopoiesis disorders are myeloproliferative (over produce)?
- Acute myeloid leukemia
- Chronic myeloid leukemia
- Myeloma
- Essential Thrombocythemia
- Polycythemia Vera
- Myelofibrosis
What malignant hematopoiesis disorders are lymphoproliferative?
- Acute lymphoblastic leukemia
- Chronic lymphocytic leukemia
- Multiple Myeloma
- Lymphoma
What are the most common malignant blood disorders?
- Leukemia
- Lymphoma
- Myeloma
Note: there can be overlap between leukemia and lymphoma
Leukemia means there are neoplastic cells in the ___?
blood stream (CA cells in blood)
Lymphoma means there are neoplastic cells in the ___?
lymph system (CA cells in lymph)
Myeloma means there are what type of neoplastic cells?
Neoplastic plasma cells (CA plasma cells)
Acute leukemia (within bone marrow) is composed of what type of cells?
Blast cells
Note: Acute = problem with immature cells (blasts)
Chronic leukemia (within bone marrow) is composed of more ____ cells?
Mature precursor cells
Leukemia Risk Factors
- Radiation
- Chemotherapy
- Benzene (second hand smoke, gas, plastics)
Leukemia Signs and Symptoms
- Leukocytosis (monocyte & lymphocyte elevation)
- Pancytopenia
- Hypogammaglobulinemia (low proteins to produce healthy immunoglobulins)
- Bone pain
- LAD
- Splenomegaly
The onset of leukemia varies. What sx/sxs would you see with acute leukemia?
- Sudden onset of a few months
- WBC high (200) - neutrophils
- Platelets low (89)
- H/H low
What sx/sxs would you see with chronic leukemia?
- Incidental diagnosis
- Not as many symptoms as acute
- Still see anemia, low platelets, no bleeding, no infection
Leukemia Dx?
- MUST do bone marrow biopsy
- Flow cytometry
What is the most common leukemia in adults?
Acute Myeloid Leukemia (AML)
Acute Myeloid Leukemia (AML) Dx?
- Circulating blasts > 20% = DX on bone marrow
- Auer rods on pathology
If you see Auer rods on pathology you should be thinking of what Dx?
Acute Myeloid Leukemia (AML)
Complications of Acute Myeloid Leukemia
- Anemia (transfusions, low circulating O2)
- Infection (low functioning WBCs)
- Bleeding (low functioning platelets)
Acute Myeloid Leukemia (AML) Tx?
- Stem cell transplant (same thing as bone marrow transplant or HCT) - curative
- High dose Chemotherapy
What is the function of a stem cell transplant?
New stem cells are reintroduced and reestablish blood cell production in the bone marrow
What is the most common childhood malignancy?
Acute Lymphoblastic Leukemia (ALL)
What is peak incidence for Acute Lymphoblastic Leukemia (ALL)?
2-5 y/o
Acute Lymphoblastic Leukemia (ALL) Risk Factors
- Genetic component
- Down Syndrome
What cell lineages comprise Acute Lymphoblastic Leukemia (ALL)?
- B-lineage (85%)
- T-lineage (15%)
- Uncommon variants/NK-lineage (<1%)
Acute Lymphoblastic Leukemia (ALL) Dx
Pathology confirms lymphoblasts
Note: leukemia = problem with blast cells
Good prognosis for Acute Lymphoblastic Leukemia (ALL)?
- Hyperdiploid (>50 chromosomes per cell)
- 2-10 y/o
- DC10+
- Low WBC count
Poor prognosis for Acute Lymphoblastic Leukemia (ALL)?
- Hypodiploid
- <2 or >10 y/o
- Male
- High WBC (>100k)
Tx for higher risk Acute Lymphoblastic Leukemia (ALL) patients?
CAR-T Therapy (usually 2nd or 3rd line therapy)